Francisco Rivas

Elastofibroma Dorsi: An Uncommon and Under-Diagnosed Tumour

Abstract Elastofibroma dorsi is a relatively rare soft-tissue tumor located at the infra-scapular level and/or subscapular regions. It usually occurs between the fourth and seventh decade of life, and is more common in females. We reviewed sixteen elastofibromas diagnosed in 12 patients (7 females, 58.3%). Four patients had bilateral elastofibromas. The most common symptom was pain. Presumptive diagnosis was made by physical examination. Chest ultrasound, computed tomography and/or magnetic resonance imaging were performed to confirm the diagnosis. Surgery was performed under general anesthesia. No major complications were observed. Elastofibromas are tumors of the chest wall with an uncertain impact. Surgical resection is indicated only in symptomatic patients.

Fibroelastoma dorsi: un tumor infrecuente e infradiagnosticado

Elastofibroma dorsi is a relatively rare soft-tissue tumour localized at the infra-scapular level and/or subscapular regions. It usually occurs between the fourth and seventh decade of life, and is more common in females. We reviewed sixteen elastofibromas diagnosed in 12 patients (7 females, 58.3%). Four patients had bilateral elastofibromas. The most common symptom was pain. Presumptive diagnosis was made by physical examination. Chest ultrasound, computed tomography and/or magnetic resonance imaging were performed to confirm the diagnosis. Surgery was performed under general anaesthesia. No major complications were observed. Elastofibromas are tumours of the chest wall with an uncertain impact. Surgical resection is indicated only in symptomatic patients.

An assessment of plantar hyperhidrosis after endoscopic thoracic sympathicolysis

BACKGROUND Endoscopic bilateral thoracic sympathicolysis (EBTS) is an effective and minimally invasive procedure used for patients with primary hyperhidrosis. The purpose of this study was to examine plantar hyperhidrosis before and after EBTS. METHODS A total of 198 patients with primary hyperhidrosis underwent 396 thoracoscopic sympathicolysis of ganglia T2-T3 in a prospective study. All completed a preoperative questionnaire, followed by a second questionnaire 12 months after the operation. The questionnaires evaluated sweating in the different body areas. Only the zones of anhydrosis were considered in delimiting the cutaneous expression of sympathetic ganglia T2-T3. RESULTS Redistribution of perspiration as reported by the patients comprised significant reductions in palmar and axillary hyperhidrosis, and an increase in the zone of the trunk and popliteal region. The incidence of plantar anhydrosis and plantar hypohidrosis was 30.3% and 20.7%, respectively (p < 0.001). CONCLUSIONS EBTS is followed by redistribution of body perspiration, with, and important, plantar anhydrosis and hypohidrosis. Although EBTS is the standard treatment for palmar primary hyperhidrosis, we must continue studying baseline sympathetic activity in patients affected by primary hyperhidrosis and the neuroanatomy of the sympathetic system to understand the redistribution of sweating and decrease of hyperhidrosis in the zones regulated by mental or emotional stimuli.

Localized (solitary) fibrous tumors of the pleura: an analysis of 15 patients.

BACKGROUND Localized fibrous tumors of the pleura (LFTPs) are rare neoplasms, which are considered to originate from submesothelial connective tissue. The aim of this article is to present 15 new cases because of their different clinical behaviors and to discuss the treatment of choice of such neoplasms. METHODS The records of 15 consecutive patients with LFTP operated at our Institution between 1995 and 2006 were retrospectively reviewed. Diagnostic procedures, clinical courses, and outcomes of these patients were studied. Total excision through a thoracotomy was performed in all patients. Neoplasms were considered to be malignant if one or more of the following histologic features were present: increasing mitotic activity; high cellularity with crowding and overlapping of nuclei; necrosis; and pleomorphism. RESULTS No operative mortality was reported. The mean follow-up time was 76 months. Malignant transformation was seen in 1 patient 26 months after resection of a benign tumor. Six cases were pathologically considered to be malignant: 2 patients developed local recurrence. One of these underwent redo-surgery and required pneumonectomy; in the other one surgery is not indicated because at the time of diagnosis the patient was 85 years. Currently, all patients are alive and 13 disease-free. CONCLUSIONS For histologically benign tumors, because of the risk of recurrence and malignant transformation, complete surgical resection is indicated and long-term follow-up is recommended in all patients. For malignant cases, complete surgical resection may be insufficient for the cure: further study should be performed to identify reliable prognostic factors to indicate and evaluate the effectiveness of systemic treatment.

Hiperhidrosis primaria. Situación actual de la cirugía del simpático

Primary hyperhidrosis-PH is an excessive sweating without known etiology. The PH is more frequent in women and in palms, soles and axillae. Medical treatment is not effective. The objective of the surgery is to remove or to disconnect sympathetic ganglia T2 (craniofacial PH or facial blushing), T3 (palmar PH) and T3-T4 (axillary PH). The surgical techniques are mainly resection/transection, ablation with electrocoagulation, sympathetic block by clipping and radiofrequency. Anhidrosis is achieved in 95% of the patients. The overall rate of complications is less than 5% and these are minor complications. The most important unwanted effect is reflex sweating, presented in 48% of the patients. Reflex sweating is more frequent in back, thorax and abdomen and it appears independently of the surgical technique. Ninety percent of the patients are very satisfied after surgery. Nowadays, thoracic sympathetic surgery is the gold standard for primary hyperhidrosis.

Intranodal thoracic schwannoma, an unusual type of neurogenic tumor

The primary intranodal schwannoma is an uncommon variant of schwannomas and extremely rare. We report the case of a 70-year-old woman who was found to have a soft tissue opacity in the right hemithorax on chest posteroanterior radiography and significant uptake of 18F-fluorodeoxyglucose on positron emission tomography. We performed thoracoscopic resection, and a definitive diagnosis of intranodal schwannoma was made from the pathological findings.

Primary hyperhidrosis. Current status of surgical treatment

Abstract Primary hyperhidrosis-PH is an excessive sweating without known etiology. The PH is more frequent in women and in palms, soles and axillae. Medical treatment is not effective. The objective of the surgery is to remove or to disconnect sympathetic ganglia T2 (craniofacial PH or facial blushing), T3 (palmar PH) and T3-T4 (axillary PH). The surgical techniques are mainly resection/transection, ablation with electrocoagulation, sympathetic block by clipping and radiofrequency. Anhidrosis is achieved in 95% of the patients. The overall rate of complications is less than 5% and these are minor complications. The most important unwanted effect is reflex sweating, presented in 48% of the patients. Reflex sweating is more frequent in back, thorax and abdomen and it appears independently of the surgical technique. Ninety percent of the patients are very satisfied after surgery. Nowadays, thoracic sympathetic surgery is the gold standard for primary hyperhidrosis.

Hemotórax masivo asociado a trombocitemia esencial después de traumatismo torácico menor

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