RESUMEN
METHODS: Four patients who previously underwent pneumonectomy for lung cancer, underwent a new contralateral resection for a metachronous cancer. Functional evaluation of these patients was not different from the standard one and included ECG, spirometry, blood gas analysis and a careful clinical evaluation. A femoro-femoral bypass was used in 2 patients to work on a collapsed lung, High Frequency Jet Ventilation was used in 1 while the last patient was hyperoxygenated and then ventilation was discontinued for the time required for the resections. RESULTS: Each method was free of complications. Operative mortality was nil. Two patients are alive free of disease at 66 and 14 months, two died for metastatic disease at 4 (N2 paratracheal nodes) and 12 months. CONCLUSIONS: Patients with a single lung should not be denied a further resection on contralateral lung. A routine evaluation of cardiopulmonary function may be sufficient but a more sophisticated evaluation including exercise oxygen consumption test, cardiac catheterization, lung perfusion scan, should be used when there is some doubt on the possibility of the patients to sustain the resection. Due to the high operative risk of this kind of patients mediastinoscopy should be performed even if preoperative CT scan of the chest shows minimally enlarged mediastinal nodes.
Asunto(s)
Carcinoma Broncogénico/cirugía , Neoplasias Pulmonares/cirugía , Pulmón/cirugía , Neoplasias Primarias Secundarias/cirugía , Neumonectomía , Adenocarcinoma/cirugía , Anciano , Carcinoma Broncogénico/mortalidad , Carcinoma de Células Grandes/cirugía , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Mediastinoscopía , Persona de Mediana Edad , Neoplasias Primarias Secundarias/mortalidad , Cuidados Preoperatorios , Respiración Artificial , Espirometría , Análisis de SupervivenciaRESUMEN
A 67 year old man presented with non-invasive thymoma, associated aplastic anemia and important hypogammaglobulinemia; the postoperative course has been characterized, three months later, by thrombocytopenia (kept under control with steroid therapy) and, two years later, by squamous lung cancer, not susceptible of surgical treatment. The patient died five years after operation because of progression of the lung cancer. Anemia improved only partially after operation; there where no effects on hypogammaglobulinemia. Thymoma has been reported in literature in 50% of patients with aplastic anemia, 7-13% of adult patients with hypogammaglobulinemia is affected by thymoma, in 21% of patients that presented with thymoma other tumors have been discovered through clinical history.
Asunto(s)
Agammaglobulinemia/complicaciones , Anemia Aplásica/complicaciones , Carcinoma de Células Escamosas/complicaciones , Neoplasias Pulmonares/complicaciones , Timoma/complicaciones , Neoplasias del Timo/complicaciones , Anciano , Humanos , Masculino , Complicaciones Posoperatorias , Radiografía Torácica , Trombocitopenia/diagnóstico , Trombocitopenia/etiología , Timoma/diagnóstico por imagen , Timoma/cirugía , Neoplasias del Timo/diagnóstico por imagen , Neoplasias del Timo/cirugía , Tomografía Computarizada por Rayos XRESUMEN
AIM: To evaluate the clinical picture, diagnostic techniques and most appropriate treatment in traumatic diaphragmatic hernia with delayed presentation on the basis of personal experience and in the light of other published studies. EXPERIMENTAL DESIGN: Review of cases treated. SETTING: Patients treated in University General Surgery wards. PATIENTS: Those patients in whom diagnosis was made some time after trauma and after the acute event were selected from a group of patients with traumatic diaphragmatic hernia. SURGERY: All patients underwent surgery to reduce hernia and repair the diaphragmatic lesion. MEASUREMENTS: All clinical findings were examined together with the tests performed and the type of treatment carried out. RESULTS: The diagnosis was made between 3 months and 3 years after the injury. Three patients presented manifest symptoms of high intestinal occlusion on entry. Radiological alterations were present in standard chest X-rays in all patients and digestive tract contrast radiography was positive for the diagnosis of hernia in 3 out of 4 cases in which it was performed; a preoperative diagnosis of hernia was obtained in 4 cases. Patients were operated using a thoracotomy (3 cases) or combined laparothoracotomy access (2 cases); the diaphragmatic lesion, localised in all cases in the cupula of the left hemidiaphragm, was repaired using separate sutures in non-reabsorbable material without the use of grafts. One patient died postoperatively owing to septic complications. CONCLUSIONS: traumatic diaphragmatic hernia with delayed presentation involves severe complications that increase morbidity and operating mortality.
Asunto(s)
Hernia Diafragmática Traumática , Adolescente , Adulto , Femenino , Hernia Diafragmática Traumática/diagnóstico , Hernia Diafragmática Traumática/cirugía , Humanos , Masculino , Persona de Mediana Edad , Radiografía Torácica , Factores de TiempoRESUMEN
AIM: Retrospective evaluation of 19 diaphragmatic ruptures due to blunt trauma. MATERIALS AND METHODS: We collected all patients with thoracic and/or abdominal blunt trauma who were admitted to the department of surgery (Clinica Chirurgica and Chirurgia generale C) from 1970 to 1995. We selected patients with ascertained diaphragmatic rupture. RESULTS: We considered 17 cases of TDR (15 males and 4 females). Mean age was 38 years (range 16-67). Radiologic findings were consistent with TDR in 10 cases out of 17 (58.8%). Right hemidiaphragm was injured in 6 cases (31.6%). 10 patients (52.6%) presented at operation with intrathoracic visceral herniation. 8 patients underwent laparotomy, 7 both laparotomy and thoracotomy, 4 thoracotomy alone. Perioperative mortality was 15.7% (3 patients). DISCUSSION AND CONCLUSIONS: The clinical features were complicated by a large number of associated lesions; radiologic diagnosis is comparatively easy if visceral herniation into the thorax is present, repeated radiologic examinations facilitate diagnosis. The surgical access is determined by concomitant associated injuries which may require urgent operation.
Asunto(s)
Diafragma/lesiones , Heridas no Penetrantes/complicaciones , Adolescente , Adulto , Anciano , Diafragma/diagnóstico por imagen , Diafragma/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/complicaciones , Radiografía , Estudios Retrospectivos , Rotura/diagnóstico por imagen , Rotura/etiología , Rotura/cirugía , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/cirugíaRESUMEN
The diagnosis of traumatic hernia of the diaphragm can be obtained at the time of injury or months-years after the trauma. The Authors report a case of traumatic hernia of the diaphragm, diagnosed 3 years after a blunt thoracic trauma in a 47-year-old man. The patient was admitted to the hospital for a pneumothorax caused by perforation of the herniated colon. He underwent colonic resection and reduction of the herniated viscera but unfortunately he died of septic shock on the 40th postoperative day. Pneumothorax is a very rare complication of traumatic diaphragmatic hernia and few cases are reported in literature. The diagnosis in the delayed phase is not easy since the correlation with the trauma is not always clear.
Asunto(s)
Hernia Diafragmática Traumática/complicaciones , Neumotórax/etiología , Hernia Diafragmática Traumática/etiología , Hernia Diafragmática Traumática/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neumotórax/diagnóstico por imagen , Radiografía , Traumatismos Torácicos/complicaciones , Factores de Tiempo , Heridas no Penetrantes/complicacionesRESUMEN
Seven patients who had undergone a pneumonectomy for lung cancer developed a second tumor in the remaining lung after a mean time of 28.5 months and underwent a further resection. Preoperative evaluation was based on standard functional tests and on the "stair climbing test". Three patients were operated on using an extracorporeal oxygenator to work on a collapsed lung, three using standard anesthesiologic techniques, and one using high-frequency jet ventilation. There was no operative mortality. Complications occurred in two patients, requiring a temporary tracheostomy in one case. No patient required home oxygen supplementation. Four patients died of metastatic disease after 4, 8, 10, and 12 months, while two patients are alive and free of disease after 83 and 9 months, one is alive and free of symptoms but with a local recurrence after 29 months. Lung resection for bronchogenic carcinoma on a single lung can be safely performed provided that careful clinical judgment is used; long-term survival can be achieved with the resection of the new tumor.