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1.
Rev Esp Anestesiol Reanim ; 46(4): 165-8, 1999 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-10365614

RESUMO

A 45-year-old woman with a posterior mediastinal tumor underwent right thoracotomy for resection, developing hypertension and difficult-to-control tachycardia while the tumor was being manipulated. A catecholamine-secreting tumor was suspected, the operation halted, and the patient prepared for surgery at a later time. The tumor was a mediastinal paraganglioma and the final outcome was satisfactory. Risk related to anesthesia is high in such patients, with perioperative mortality ranging from 40 to 85%. Correct diagnosis and appropriate preoperative drug preparation with adrenergic receptor blockers appreciably decreases morbidity and mortality related to surgery. We discuss the effect of labetalol on such tumors and describe our observations.


Assuntos
Neoplasias do Mediastino/diagnóstico , Paraganglioma/diagnóstico , Catecolaminas/metabolismo , Feminino , Humanos , Complicações Intraoperatórias , Período Intraoperatório , Neoplasias do Mediastino/metabolismo , Neoplasias do Mediastino/cirurgia , Pessoa de Meia-Idade , Paraganglioma/metabolismo , Paraganglioma/cirurgia
2.
Arch Bronconeumol ; 34(3): 112-8, 1998 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-9611634

RESUMO

The Task Force on Pulmonary Metastasis Surgery of the Oncology Department of the Madrid Pneumology and Chest Surgery Society designed a questionnaire to determine guidelines for surgery to resect lung metastases in the Autonomous Community of Madrid, an area with over four million inhabitants. The questionnaire was divided into five sections: indications, diagnostic procedures, extension studies, disciplinary foci and surgical techniques. Ten of the hospitals surveyed answered the questionnaire. We found that disagreement is high regarding patient screening, and that there are differences regarding some preoperative procedures and extension studies, as well as in therapeutic approach. Eighty percent of the respondents were not in favor of using video assisted thoracoscopy as a therapeutic technique, and disagreement was greater regarding approaches technique, and disagreement was greater, regarding approaches to bilateral metastases. We infer that between 100 and 120 cases are treated surgically every year. Procedures to join The International Lung Metastases Registry have started.


Assuntos
Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Hospitais , Humanos , Espanha , Inquéritos e Questionários
4.
An Med Interna ; 14(11): 579-82, 1997 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-9445586

RESUMO

A case with recurrent hypoglycemias following a thoracic tumor is presented. Neurologic symptoms due to hypoglycemia were dominant. Subcutaneous somatostatin was administrated preoperatively and hypoglycemia was controlled following tumor resection. Histology analysis shows a localized fibrous pleural tumor. Origin has been widely questioned but now it is accepted to be mesenchymal and not mesothelial. Lung disease owing to chronic compression of the tumor made necessary a lobectomy. Postoperative atelectasis required reoperation and a pneumonectomy was performed. To date insulin-like factors secreted by the tumor are supposed to be responsible for hypoglycemics discharges.


Assuntos
Hipoglicemia/etiologia , Mesotelioma/complicações , Neoplasias Pleurais/complicações , Humanos , Hipoglicemia/diagnóstico , Fator de Crescimento Insulin-Like I/análise , Fator de Crescimento Insulin-Like II/análise , Masculino , Mesotelioma/diagnóstico , Pessoa de Meia-Idade , Neoplasias Pleurais/diagnóstico
5.
Arch Bronconeumol ; 33(9): 450-2, 1997 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-9424261

RESUMO

We describe the results of treating symptomatic pleural effusion by implanting a Pleurocath-type small-caliber catheter connected to a three-way valve for external evacuation. The method was used in 6 patients with advanced neoplastic disease and dyspnea related to pleural effusion that could not be treated with the usual methods of pleurodesis. Dyspnea disappeared or was significantly relieved in 5 of the 6 patients, such that follow-up could be continued on an outpatient basis for 3. Catheters remained in position for periods of time ranging from 14 days to 10 months. Survival varied from 14 days to 14 months. The only important complication was one case of infection in the area of catheter insertion. We describe the extremely simple technique used and the results that have encouraged us to continue using the method in cases that meet the necessary conditions.


Assuntos
Drenagem/métodos , Derrame Pleural Maligno/terapia , Idoso , Idoso de 80 Anos ou mais , Cateterismo/instrumentação , Cateterismo/métodos , Drenagem/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/diagnóstico por imagem , Estudos Prospectivos , Radiografia Torácica , Fatores de Tempo
6.
Arch Bronconeumol ; 32(8): 394-6, 1996 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-8983566

RESUMO

The spread of oropharyngeal infections to the mediastinum can give rise to descending necrotizing mediastinitis (DNM), which causes a high rate of mortality (around 40%), particularly when diagnosis is late and drainage inadequate. In the first case we report, successful drainage of the mediastinum was achieved at the cervical and sub-xiphisternum levels and by thoracotomy. Given the condition of the second patient, transcervical drainage alone was considered the best option, but this treatment was inadequate. Rapid start of appropriate drainage of the mediastinum is of great importance. Cervical drains, which may be adequate when there is perforation of the cervical esophagus, is insufficient in DNM, which calls for more aggressive, early drainage, such as can be achieved by thoracotomy. Computerized axial tomography of the chest is essential for rapid diagnosis, to plan the most appropriate surgical approach and for follow-up and evaluation of drainage.


Assuntos
Mediastinite/etiologia , Faringite/complicações , Idoso , Drenagem , Evolução Fatal , Feminino , Humanos , Mediastinite/diagnóstico por imagem , Mediastinite/cirurgia , Orofaringe , Choque Séptico/etiologia , Tomografia Computadorizada por Raios X
7.
Arch Bronconeumol ; 32(1): 43-6, 1996 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-8948889

RESUMO

Localized fibrous tumor is an uncommon neoplasm that is usually located in the visceral pleura. Histologically these tumors are composed of randomly arranged fascicles or networks of fusiform cells, among which there is a varying amount of collagen. Most authors consider that these cells originate in submesothelial mesenchymal cells. The condition is normally silent, though hypoglycemia, hypertrophic osteoarthropathy or other symptoms sometimes result. The treatment of choice is total resection and imaging techniques are extremely helpful for establishing surgical strategy, even though surgery is often performed before a histopathologic diagnosis is available. We present 2 patients with intrapulmonary fibromas that were histologically identical to localized fibrous pleural tumors. These tumors are rarely found in the parenchyma and multiple bilateral presentation is exceptional, having been described only once in the literature. One of our patients had a single pulmonary node that happened to be noticed on an X-ray. The other had multiple bilateral nodes that required several surgical procedures; the intraparenchymatous location for this type of tumor has not been described to date. We discuss clinical, therapeutic and histopathological aspects of these tumors and review the literature.


Assuntos
Neoplasias Pulmonares/patologia , Mesotelioma/patologia , Feminino , Humanos , Pessoa de Meia-Idade
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