RESUMEN
The most common malignant neurogenic tumors in children are neuroblastic tumors, classified as ganglioneuroblastoma or neuroblastoma. Ganglioneuroblastomas usually occur at the sympathetic ganglia in the mediastinum, whereas neuroblastomas occur in the abdominal cavity. We describe a case of large posterior mediastinal ganglioneuroblastoma extending from the aortic arch to the left renal hilum in a 17-year-old boy. Despite chemotherapy, post-treatment computed tomography showed disease progression. The patient underwent a thoracolaparotomy incision and excision of the tumor. These malignant mediastinal tumors can potentially grow to a very large size. If alternative treatment has failed, resection can be accomplished with relative safety.
Asunto(s)
Ganglioneuroblastoma/patología , Neoplasias del Mediastino/patología , Carga Tumoral , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Aorta Torácica , Carboplatino/administración & dosificación , Progresión de la Enfermedad , Etopósido/administración & dosificación , Resultado Fatal , Ganglioneuroblastoma/terapia , Humanos , Riñón , Laparotomía , Masculino , Neoplasias del Mediastino/terapia , Neoplasia Residual , Toracotomía , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Endobronchial fungal infection (EBFI) is notoriously difficult to diagnose early since it may present few systemic features and does not cause characteristic parenchymal lesions on lung CT scanning. We report a 9-year-old girl who suffered extended neutropenia following graft failure after haematopoietic stem cell transplantation (HSCT) for severe aplastic anaemia. CT scan prior to retransplantation was normal despite persistent cough but lobar collapse was shown on repeat scan 16 days later. The probable diagnosis of EBFI (later proven on bronchoscopy) was only suspected when subsequent chest X-ray (CXR) demonstrated lack of an air bronchogram in the partially collapsed lung. Early radiological suspicion resulted in multiagent antifungal therapy followed by delayed lobectomy, and led to this being the first reported case of Aspergillus EBFI not to result in respiratory failure.
RESUMEN
We describe the case of a previously well young man who presented acutely to hospital with a history of progressive chest symptoms and systemic upset. At admission, clinical evidence of left upper lobe collapse on respiratory examination and chest x-ray gave rise to significant clinical concern. Initial assessment by CT suggested a possible aspirated foreign body in the left upper lobe bronchus with distal left upper lobe collapse. Subsequent rigid bronchoscopy identified a solid abnormality totally occluding the left upper lobe bronchus, which did not appear to be a foreign body. The patient became progressively more unwell with clinical signs of chest sepsis and failed to settle with medical therapy. A decision was made to undertake a lobectomy to remove the collapsed lobe and obstructing endobronchial lesion. Histology confirmed that the cause of bronchial obstruction was a mesenchymoma (pulmonary hamartoma).
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Bronquios/patología , Enfermedades Bronquiales/complicaciones , Hamartoma/complicaciones , Adulto , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/cirugía , Enfermedades Bronquiales/diagnóstico , Enfermedades Bronquiales/cirugía , Broncoscopía , Diagnóstico Diferencial , Cuerpos Extraños/diagnóstico , Hamartoma/diagnóstico , Hamartoma/cirugía , Humanos , Masculino , Neumonectomía , Tomografía Computarizada por Rayos XRESUMEN
UNLABELLED: Ventilation-associated neonatal barotrauma comprises a spectrum of conditions including pneumothorax, pulmonary interstitial emphysema, pneumopericardium and pneumomediastinum. Whilst pneumothorax is common, mediastinal and particularly posterior mediastinal air collections are rare. We report the case of a neonate, presenting with life threatening pericardial tamponade secondary to posterior tension pneumomediastinum. The infant was successfully resuscitated with an emergency left lateral thoracotomy and chest drain insertion. We believe this to be the first such case reported in the literature. We discuss aspects of pathophysiology, diagnosis and management relating to posterior pneumomediastinum. CONCLUSION: Posterior pneumomediastinum is rare, but can potentially cause fatal tamponade. Such cases must be managed in a tertiary centre where cardiology and surgical expertize are available.
Asunto(s)
Barotrauma/complicaciones , Taponamiento Cardíaco/etiología , Enfermedades del Prematuro/etiología , Enfisema Mediastínico/etiología , Respiración Artificial/efectos adversos , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/cirugía , Drenaje , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/cirugía , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/cirugía , ToracotomíaRESUMEN
Cervical mediastinoscopy has been widely used and is considered a safe method for the histologic diagnosis and staging of many conditions. Hemorrhage still remains one of the main possible complications, and hemostasis is usually achieved without any further surgical intervention. We present a previously unreported complication of absorbable hemostatic gauze packing, which led to superior vena caval injury and multiple pulmonary emboli, necessitating further surgical repair with the use of a veno-venous shunt.
Asunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Esponja de Gelatina Absorbible/efectos adversos , Hemostasis Quirúrgica/métodos , Hemostáticos/efectos adversos , Mediastinoscopía/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodos , Vena Cava Superior/lesiones , Adulto , Biopsia con Aguja/efectos adversos , Diagnóstico Diferencial , Estudios de Seguimiento , Esponja de Gelatina Absorbible/administración & dosificación , Hemostáticos/administración & dosificación , Humanos , Enfermedades Linfáticas/diagnóstico , Masculino , Mediastino , Radiografía Torácica , Tomografía Computarizada por Rayos XRESUMEN
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether surgical resection of non-small cell lung cancer (NSCLC) with cerebral metastasis prolongs survival. Altogether 153 relevant papers were identified using the below mentioned search, 11 papers represented the best evidence to answer the question. The author, date, journal, country of publication, study type, patient group studied, relevant outcomes, results and study weaknesses were tabulated. A vast majority of patients with synchronous presentation underwent cerebral metastasectomy prior to lung resection which led to a rapid regression of neurological symptoms. In these studies, the median survival for the curative intent groups (bifocal therapy+/-adjuvant treatment) ranged from 19 to 27 months (mean 23.12+/-3.3 months) and at 1, 2 and 5 years from 56% to 69% (mean=63.9+/-5.6%), 28% to 54% (mean=38.7+/-11%) and 11% to 24% (mean=18+/-5.7%), respectively. In comparison, the median and 1-year survival of the palliative groups were 7.1-12.9 months (mean=10.3+/-2.9 months) and 33-39.7% (mean=35.3+/-3.8%), respectively. We conclude that in the absence of mediastinal lymph node involvement, surgical resection of NSCLC with complete resection of the brain metastasis improves prognosis. Further, adenocarcinoma, low CEA levels at presentation, response to preoperative chemotherapy before focal treatment and a high Karnofsky performance score (KPS) may have a positive prognostic value.
Asunto(s)
Adenocarcinoma/cirugía , Neoplasias Encefálicas/cirugía , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Craneotomía , Neoplasias Pulmonares/cirugía , Neumonectomía , Adenocarcinoma/mortalidad , Adenocarcinoma/secundario , Benchmarking , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/secundario , Antígeno Carcinoembrionario/sangre , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Quimioterapia Adyuvante , Medicina Basada en la Evidencia , Humanos , Estado de Ejecución de Karnofsky , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Terapia Neoadyuvante , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
We report the case of an 18-year-old patient who underwent Ravitch procedure for pectus carinatum and subsequently had septic shock develop with severe cardiac dysfunction requiring treatment with extracorporeal membrane oxygenation. We advocate the use of extracorporeal membrane oxygenation in adult patients with intractable cardiorespiratory failure due to sepsis post-thoracic surgery unresponsive to conventional therapy.
Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Insuficiencia Cardíaca/terapia , Choque Séptico/terapia , Infecciones Estafilocócicas/terapia , Infección de la Herida Quirúrgica/terapia , Adolescente , Antibacterianos/uso terapéutico , Terapia Combinada , Progresión de la Enfermedad , Drenaje/métodos , Estudios de Seguimiento , Tórax en Embudo/diagnóstico , Tórax en Embudo/cirugía , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Contrapulsador Intraaórtico , Masculino , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Medición de Riesgo , Choque Séptico/etiología , Choque Séptico/fisiopatología , Infecciones Estafilocócicas/diagnóstico , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/fisiopatología , Toracotomía/efectos adversos , Toracotomía/métodos , Resultado del TratamientoRESUMEN
The question addressed by a best evidence topic approach using a structured protocol was whether pleurectomy using video-assisted thoracoscopic surgery (VATS) resulted in better outcomes than open pleurectomy for primary spontaneous pneumothorax. Altogether 45 relevant papers were identified of which nine papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that VATS pleurectomy has been shown to be comparable to open pleurectomy in the treatment of spontaneous pneumothorax, with a meta-analysis and several RCTs showing reductions in length of hospital stay and analgesic requirements. Postoperative pulmonary dysfunction has also been shown to be reduced after VATS pleurectomy in two RCTs, although a third study found no significant difference. A concern may be a four-fold increase in the recurrence of pneumothorax following VATS pleurectomy as compared to open pleurectomy reported in a recent meta-analysis of four randomised and 25 non-randomised studies performed in 2007 and published in the Lancet, although a second meta-analysis of only the randomised trials did not show this difference.
Asunto(s)
Pleura/cirugía , Neumotórax/cirugía , Procedimientos Quirúrgicos Pulmonares/métodos , Cirugía Torácica Asistida por Video , Adulto , Analgésicos/uso terapéutico , Benchmarking , Ensayos Clínicos como Asunto , Medicina Basada en la Evidencia , Femenino , Humanos , Tiempo de Internación , Masculino , Metaanálisis como Asunto , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Procedimientos Quirúrgicos Pulmonares/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Cirugía Torácica Asistida por Video/efectos adversos , Toracotomía , Resultado del TratamientoRESUMEN
Benign mesenchymoma is a rare type of germ cell tumour. An extensive literature search revealed only one described case of mediastinal mesenchymoma in Europe and three cases in Asia. We describe our recent experience of a mediastinal mesenchymoma and present the fascinating imaging and operative findings. The preoperative diagnosis of these lesions remains difficult and therefore surgical resection is recommended.
RESUMEN
Spontaneous esophageal rupture is an uncommon and poorly understood condition. Recurrent rupture is extremely rare, with only one previously reported case in the literature. Here, we present a case series of two patients who had recurrent ruptures, and discuss the principles underlying the management of such cases.
Asunto(s)
Enfermedades del Esófago/cirugía , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Rotura Espontánea/cirugía , Resultado del TratamientoRESUMEN
Recent surveys have uncovered major variations in key aspects of intercostal drain management, suggesting that decisions are being made on individual preferences without resorting to sound evidence. We provide an up-to-date review of the best practice with evidence-based recommendations and expert consensus views. The following aspects of chest drain management have been addressed: indications for drainage, insertion technique, complications, management of an indwelling chest drain, indications and technique for removal. The emphasis in this review is that safe intercostal drain practice relies upon adherence to a few important principles. Furthermore, when in doubt, particularly with a complex thoracic problem, one should seek prompt specialist advice.
Asunto(s)
Tubos Torácicos , Drenaje/métodos , Tubos Torácicos/efectos adversos , Toma de Decisiones , Medicina Basada en la Evidencia , Humanos , Neumotórax/terapia , Guías de Práctica Clínica como Asunto , Administración de la Seguridad , SucciónRESUMEN
Ectopic thyroid tissue in the chest is rare. We report a case of a euthyroid patient with benign ectopic thyroid tissue presenting as a thymic mass in association with a multinodular goiter. Both disorders were managed successfully by surgical intervention.
Asunto(s)
Coristoma/cirugía , Bocio Nodular/cirugía , Enfermedades Linfáticas/cirugía , Timo , Glándula Tiroides , Coristoma/complicaciones , Bocio Nodular/complicaciones , Humanos , Enfermedades Linfáticas/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: There is evidence that perioperative blood transfusion may lead to immunosuppression. Our aim was to determine whether blood transfusion influenced survival after esophagectomy for carcinoma. METHODS: The study group comprised 234 consecutive patients (175 men and 59 women) with a mean age of 66 years who underwent esophagectomy for carcinoma by one surgeon between 1988 and 1998. The impact of 41 variables on survival was determined by means of univariate and multivariate analysis. Follow-up was complete (mean follow-up, 19.2 months; standard deviation, 16 months; range, 0 to 129 months). RESULTS: The operative mortality rate was 5.6% (13 deaths). Median operative blood loss was 700 mL (range, 150 to 7,000 mL). One hundred sixty-one patients (68.8%) received a blood transfusion postoperatively (mean transfusion, 2.6 units; range, 0 to 12 units). Overall actuarial 1-year, 3-year, and 5-year survival rates inclusive of operative mortality were 58.1%, 28.5%, and 16.1%, respectively. On univariate analysis, positive lymph nodes, pathological TNM stage, transfusion of more than 3 units of blood, incomplete resection, poor tumor cell differentiation, longer tumor, greater weight loss, male sex, and adenocarcinoma were significant (p < 0.05) negative factors for survival. On Cox proportional hazards regression analysis, after excluding operative mortality, lymph node involvement (p = 0.001), incomplete resection (p = 0.0001), poor tumor cell differentiation (p = 0.04), and transfusion of more than 3 units of blood (p = 0.04) were independent adverse predictors of late survival. CONCLUSIONS: In addition to reaffirming the importance of completeness of resection and nodal involvement, this study demonstrates that blood transfusion (more than 3 units) may have a significant adverse effect on late survival after esophageal resection for carcinoma. Every effort should be made to limit the amount of transfused blood to the absolutely essential requirements.