RESUMEN
A 62-year-old man was admitted to the hospital due to sepsis secondary to a hemodialysis catheter-related infection that, upon diagnostic evaluation, demonstrated to be caused by P. aeruginosa and was treated with meropenem. Eradication of the infectious episode was confirmed by blood workup, including cultures. One month after the initial episode, the patient was readmitted due to a symptomatic penetrating aortic ulcer, which was classified as a cardiovascular emergency. The patient underwent an aortic stent-graft placement. Four weeks later, he presented to the emergency department with a 2-hour onset of thoracic pain and massive hematemesis. The esophagus and aortic segment with aortic stent graft were resected en bloc after an aortoesophageal fistula was diagnosed.
Asunto(s)
Aneurisma de la Aorta Torácica , Enfermedades de la Aorta , Implantación de Prótesis Vascular , Fístula Esofágica , Fístula Vascular , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/etiología , Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular/efectos adversos , Fístula Esofágica/diagnóstico por imagen , Fístula Esofágica/etiología , Fístula Esofágica/cirugía , Humanos , Masculino , Persona de Mediana Edad , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiología , Fístula Vascular/cirugíaRESUMEN
Background Infectious lung cavities are a common entity for the respiratory physician. Sometimes these lesions require surgical treatment, but surgery is challenging, and complications are common. Methods Patients with infectious lung cavities amenable to surgical treatment were included in a case-control study. The control group included patients with no complications. The cases group comprised patients with any of the following complications up to 90 days after surgery: death, persistence of hemoptysis, empyema, operative blood loss > 500 mL, vascular lesion requiring repair, massive transfusion (>5 units of packed red blood cells per 48 h) or reoperation for bleeding, postoperative mechanical ventilation, intensive care unit stay > 48 h, prolonged air leak, and persistent atelectasis. The potential risk factors for complications analyzed were demographic data, exposure to contaminants, comorbidities, preoperative embolization, surgical indication, spirometry results, and sputum test positive for Mycobacterium tuberculosis. Results Forty-five patients were included in the study and divided into 24 cases and 21 controls. We found a significant difference in the time to removal of chest tubes in favor of the noncomplicated cases (6.45 vs. 4.05 days, p = 0.030), and persistent active infection at the time of surgery tended to be a risk factor for complications (odds ratio = 6.6, 95% confidence interval: 0.7-60, p = 0.061). Conclusion The presence of persistent active infection at the time of surgery could be a risk factor for complications in resection surgery for infectious lung cavities.
Asunto(s)
Neumonectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Infecciones del Sistema Respiratorio/cirugía , Pérdida de Sangre Quirúrgica , Distribución de Chi-Cuadrado , Empiema Pleural/etiología , Transfusión de Eritrocitos/efectos adversos , Femenino , Hemoptisis/etiología , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Neumonectomía/mortalidad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Hemorragia Posoperatoria/etiología , Atelectasia Pulmonar/etiología , Respiración Artificial/efectos adversos , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Poland Syndrome is a rare disease with an incidence of 1 in 30,000. This disease is characterized by agenesis of the pectoralis major, hypoplasia of mammarian tissue and the nipple complex, and limb abnormalities. The severe form of this disease can be associated with rib and sternal malformations like pectus excavatum. A 19-year-old man with severe Poland syndrome with cardiac extrasystoles and restrictive ventilation as shown by a spirometry test is presented. A total sternal reconstruction with partial osteotomies and bilateral resection of cartilage was performed. The sternum was stabilized with underlying titanium bars and clips. The cosmetic result was satisfactory.
Asunto(s)
Tórax en Embudo/cirugía , Procedimientos de Cirugía Plástica/métodos , Síndrome de Poland/cirugía , Esternón/cirugía , Tomografía Computarizada por Rayos X/métodos , Estudios de Seguimiento , Tórax en Embudo/complicaciones , Tórax en Embudo/diagnóstico por imagen , Humanos , Fijadores Internos , Masculino , Osteotomía/métodos , Dimensión del Dolor , Posicionamiento del Paciente , Músculos Pectorales/anomalías , Músculos Pectorales/cirugía , Síndrome de Poland/complicaciones , Síndrome de Poland/diagnóstico por imagen , Calidad de Vida , Enfermedades Raras , Procedimientos de Cirugía Plástica/instrumentación , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Prolonged air leak after pleural decortication is one of the most frequent complications. OBJECTIVE: The aim of this study is to compare the effects of prolonged air leak between the digital chest drainage (DCD) system and the classic drainage system in patients with empyema class IIB or III (American Thoracic Society classification) in pleural decortication patients. MATERIAL AND METHODS: A total of 37 patients were enrolled in a prospective randomized control trial over one year, consisting of 2blinded groups, comparing prolonged air leak as a main outcome, the number of days until removal of chest drain, length of hospital stay and complications as secondary outcomes. RESULTS: The percentage of prolonged air leak was 11% in the DCD group and 5% in the classic group (P=0.581); the mean number of days of air leak was 2.5±1.8 and 2.4±2.2, respectively (P=0.966). The mean number of days until chest tube removal was 4.5±1.8 and 5.1±2.5 (P=0.41), the length of hospital stay was 7.8±3.7 and 8.9±4.0 (P=0.441) and the complication percentages were 4 (22%) and 7 (36%), respectively (P=0.227). DISCUSSION: In this study, no significant difference was observed when the DCD was compared with the classic system. This was the first randomized clinical trial for this indication; thus, future complementing studies are warranted.
Asunto(s)
Drenaje/efectos adversos , Empiema Pleural/cirugía , Complicaciones Intraoperatorias/prevención & control , Pleura/lesiones , Neumotórax/prevención & control , Complicaciones Posoperatorias/prevención & control , Adulto , Anciano , Tubos Torácicos , Drenaje/instrumentación , Drenaje/métodos , Femenino , Hemotórax/etiología , Humanos , Complicaciones Intraoperatorias/etiología , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pleura/cirugía , Neumotórax/etiología , Complicaciones Posoperatorias/etiología , Estudios ProspectivosRESUMEN
Tracheobronchial stenosis is common in the thoracic surgery service, and iatrogenic injury of the airway after manipulation is not infrequent. When a digital thoracic drainage system came onto the market, many advantages were evident. A 24-year-old woman with critical right main bronchial stenosis underwent airway dilation that was complicated by a tear with a massive air leak, resulting in a total right pneumothorax. We employed a pleural drain connected to a digital thoracic drainage system. The drain was removed 2 days after successful resolution of the air leak.
Asunto(s)
Obstrucción de las Vías Aéreas/terapia , Bronquios/lesiones , Enfermedades Bronquiales/terapia , Dilatación/efectos adversos , Drenaje/instrumentación , Neumotórax/terapia , Obstrucción de las Vías Aéreas/diagnóstico , Enfermedades Bronquiales/diagnóstico , Drenaje/métodos , Diseño de Equipo , Femenino , Humanos , Neumotórax/diagnóstico , Neumotórax/etiología , Resultado del Tratamiento , Adulto JovenRESUMEN
Kirschner wires are often used for the stabilization of complex fractures. Wire migration is a rare but still recognized complication of its use. A 56-year-old man suffered a clavicle fracture at age 26 that was stabilized with one Kirschner wire, and for 30 years he was asymptomatic. Recently, he presented with cough and right thoracic pain. Chest radiographs revealed migration of the Kirschner wire, and thoracoscopic visualization revealed that the Kirschner wire had penetrated the middle lobe parenchyma and was in close contact with the right auricle. This case study reports the successful thoracoscopic treatment of a rare complication of Kirschner wire migration.
Asunto(s)
Hilos Ortopédicos/efectos adversos , Migración de Cuerpo Extraño/cirugía , Pulmón/cirugía , Toracoscopía , Clavícula/lesiones , Clavícula/cirugía , Migración de Cuerpo Extraño/etiología , Fracturas Óseas/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Myofibroblastic inflammatory tumors (MIT) of location in carina represent a diagnostic, classification, and treatment challenge, due to the scarcity of reports. The actual evidence supports the theory that MITs are lower-grade sarcomas. Here we present the case of a 23-year-old man with MIT in carina who was treated with tumor resection by carinectomy and tracheobronchial reconstruction. In spite of the few reports of these tumors in that location, the surgical treatment looking for complete resection is the gold standard of treatment.