Solitary fibrous tumors of the pleura: a clinical-pathological characterization emphasizing changes in lung function.

Solitary fibrous tumors of the pleura (SFTP) represent less than 5% of all pleural tumors with a higher susceptibility for men in the sixth and seventh decades of life. Imaging and histopathological analyses indicate that these tumors have an unpredictable clinical course since larger tumors are often associated with malignancy; however, this assumption is not universal. In addition, there are no systematic descriptions of lung function in either the basal or post-surgical scenarios of SFTP patients. We describe a series of 3 patients between 4th and 5th decade of life with a benign histopathological SFTP without local recurrence in their follow-up. We also analyzed changes in lung function, emphasizing possible associations with clinical recovery.

Bleomycin-Induced Cryptogenic Organizing Pneumonia Manifested as Spontaneous Pneumothorax in a Patient with Classic Seminoma.

Cryptogenic Organizing Pneumonia (COP) can manifest like a collagen disorder or infectious diseases, or be caused by drug induced toxicity. This paper presents the case of a 24 year-old man diagnosed with classic seminoma, treated with chemotherapy scheme that included bleomycin (accumulated dose, 120 units). The patient was admitted at the hospital due to rapidly-progressing dyspnea and thoracic pain. The diagnostic approach revealed the presence of a spontaneous pneumothorax, while a lung biopsy documented COP. Despite treatment, the patient died from disease progression.

Manejo del empiema complicado con ventana torácica y sistema de presión negativa / Management of complicated empyema with thoracic window and negative pressure system

Introducción: El empiema torácico se define como derrame pleural purulento. La causa más frecuente es el infeccioso paraneumónico, sin embargo, puede presentarse en escenarios posquirúrgicos o postraumáticos. El empiema sigue una evolución progresiva trifásica y el tratamiento debe enfocarse a la causa de la enfermedad, fase evolutiva, y el estado general del paciente. Algunos casos requieren toracotomía con drenaje abierto tipo ventana torácica para solucionar el padecimiento. Materiales y Método: Estudio observacional, retrospectivo y descriptivo basado en una serie de casos. Se analizaron datos de pacientes consecutivos con empiema intervenidos con toracotomía con drenaje abierto tipo ventana torácica y uso de sistema de presión negativa en un Hospital de 3er Nivel del Sureste de México de octubre 2015 a junio 2017. Resultados: Se analizaron seis casos, la mediana de edad fue 46 años (rango intercuartílico 34-47) y 67% eran hombres. El sistema de presión negativa se colocó en el periodo posquirúrgico con una mediana de 6 días (rango intercuartílico 5-7). El tiempo medio de permanencia fue de 61 días (RIC 43-148). Finalmente, el tiempo de estancia hospitalaria fue de 72 días (RIC 49-87). El 67% de los casos evolucionó con cierre de la ventana torácica y adecuada expansión pulmonar. Conclusiones: En pacientes con empiema crónico, la terapia integral que incluya toracotomía con ventana torácica y el uso de sistema de presión negativa es una estrategia aceptable de tratamiento. Se requieren más estudios que ratifiquen los resultados de forma más objetiva.

Background: Thoracic empyema is defined as a purulent pleural effusion. Its most common origin is parapneumonic, nonetheless, post-surgical or post-traumatic empyema can also occur. Empyema has a progressive three-phase evolution and the treatment must focus to the evolutionary phase, cause of the disease and overall state of the patient. Some cases would undergo through thoracotomy with thoracic window open drainage to solve the disease. Material and Methods: This is an observational, retrospective and descriptive study based on all consecutive patients with empyema who underwent thoracotomy with thoracic window open drainage in a 3rd level hospital in the southeast of Mexico between october 2015 and june 2017. Results: We identified 6 cases. Median of age was 46 years (IQR 34-47) and 67% were male. The negative pressure system was placed in the 6th day of surgery (IQR 5-7). Median time of use was 61 days (IQR 43-148). Finally, the length of hospital stay was 72 days (IQR 49-87). 67% of the cases had chest window closure with adequate lung expansion. Conclusions: when we face a clinical scenario with chronic empyema, an integral therapy that includes thoracic window thoracotomy with a negative pressure system is an acceptable treatment strategy. Subsequent studies are required in order to ratify the results

Management of Complicated Empyema with Thoracic Window and Negative Pressure System

Introduction: the thoracic empyema is defined as a purulent pleural effusion. Its most frequent cause is infectious parapneumonic effusion; however, postsurgical or posttraumatic empyema can also occur. The empyema has a progressive three-phase evolution and its treatment shall focus on the cause of the disease, the evolutionary phase and the general condition of the patient. In order to cure this condition, some cases require thoracotomy with open thoracic window drainage. Materials and Method: observational, retrospective and descriptive study based on a series of cases. We analyzed data from consecutive patients with empyema who underwent thoracotomy with open thoracic window drainage and using a negative pressure system in a third-level care hospital in the southeast of Mexico between October 2015 and June 2017. Results: we analyzed 6 cases. Median of age was 46 years (interquartile range 34-47), and 67% were male. The negative pressure system was placed during the postsurgical period, with a median of 6 days (interquartile range 5-7). The mean permanence time was 61 days (IQR 43-148). Finally, the length of hospital stay was 72 days (IQR 49-87). 67% of the cases had thoracic window closure and adequate lung expansion. Conclusions: in patients with chronic empyema, an integral therapy including thoracic window thoracotomy with a negative pressure system is an acceptable treatment strategy. More studies are required in order to ratify the results more objectively.

Manejo del empiema con un sistema cerrado de succión y reconstrucción de ventana torácica en un paciente con cirrosis hepática / Management of Pleural Empyema With a Vacuum-Assisted Closure Device and Reconstruction of Open Thoracic Window in a Patient With Liver Cirrhosis

Mujer de 21 años diagnosticada de cirrosis criptogénica desde los 9 años de edad, que presentó empiema izquierdo posneumónico que no remitió con el tratamiento médico convencional y evolucionó con fistulización hacia la piel en el séptimo espacio intercostal a nivel subescapular izquierdo. Se realizó una ventana torácica abierta y al sexto día se envió a su domicilio con colocación de sistema cerrado de succión portátil, con cambios cada 4 días del material hasta la obliteración total de la cavidad (92 días). Se observó por imagen una expansión completa del pulmón y se realizó reconstrucción de la pared torácica con barras de titanio. La alta mortalidad del empiema, en los pacientes con hepatopatías, requiere la implementación y la búsqueda de nuevas terapias adyuvantes, como la utilización del sistema cerrado de succión y la reconstrucción con barras de titanio. Para una adecuada evaluación, se requieren estudios controlados con una serie de casos amplia (AU)

The patient is a 21-year-old female, diagnosed with cryptogenic cirrhosis at the age of 9. She presented with left post-pneumonic empyema that did not remit with conventional medical management and evolved with fistulization to the skin in the 7th intercostal space in the left subscapular region. We performed an open thoracic window procedure, and on the 6th day the patient was sent home with a portable vacuum-assisted closure device, with changes of the material every 4 days until the cavity was completed obliterated (92 days). Imaging tests showed full expansion of the lung, and chest wall reconstruction was performed with titanium rods. The high mortality of empyema in patients with liver disease requires both implementing and searching for new adjuvant therapies, like the use of vacuum-assisted closure systems and reconstruction with titanium rods. Controlled studies with a wide range of cases are needed for proper evaluation (AU)

Management of pleural empyema with a vacuum-assisted closure device and reconstruction of open thoracic window in a patient with liver cirrhosis.

The patient is a 21-year-old female, diagnosed with cryptogenic cirrhosis at the age of 9. She presented with left post-pneumonic empyema that did not remit with conventional medical management and evolved with fistulization to the skin in the 7th intercostal space in the left subscapular region. We performed an open thoracic window procedure, and on the 6th day the patient was sent home with a portable vacuum-assisted closure device, with changes of the material every 4 days until the cavity was completed obliterated (92 days). Imaging tests showed full expansion of the lung, and chest wall reconstruction was performed with titanium rods. The high mortality of empyema in patients with liver disease requires both implementing and searching for new adjuvant therapies, like the use of vacuum-assisted closure systems and reconstruction with titanium rods. Controlled studies with a wide range of cases are needed for proper evaluation.

Tracheal dimensions in the Mexican population.

BACKGROUND: There are few studies regarding the measurement of tracheal dimensions. Most are focused on morphology and tracheal development. The aim of this study was to determine the length and tracheal diameter of adults in our population and its correlation with external measurements. METHODS: The study design was prospective, observational and descriptive. We included a nonrandom sampling of deaths of Mexican national citizens who were between 18 and 65 year old. The study period was from June 1 to November 30, 2009, and the study was carried out at the facilities of the Forensic Medical Service of the Federal District, Mexico. Standardized measurements of tracheal diameter and length were correlated with external measurements. RESULTS: We dissected 44 cadavers, 19 (43%) females and 25 (57%) males. In females the average age was 39.2 ± 13.9 years (range: 19-61 years), average height 161.9 ± 7.4 cm (range: 154-179 cm), tracheal length (TL) 8.6 ± 0.5 cm (range: 7.8-9.5 cm) and transverse diameter (TD) 1.7 ± 0.3 cm (range: 1.3-2.0 cm). Average age of males was 36.4 ± 14.4 years (range: 19-65 years), average height 169.8 ± 6.7 cm (range: 156-184 cm), TL 9.1 ± 0.9 cm (range: 8.0-10.7) and TD 1.9 ± 0.2 cm (range: 1.6-2.3 cm). TL was significantly correlated with sternal length (0.82, p <0.0001) and age (0.56, p = 0.0003). According to gender, there was no significant correlation between TL and height. CONCLUSIONS: We found a low average TL and no significant correlation with height. These data should be considered when carrying out direct procedures on the trachea.