J. Sánchez-Lloret

Experimental reconstruction of the canine trachea with a free revascularized small bowel graft

Extensive tracheal stenotic lesions caused by tracheomalacia or neoplasms represent a surgical challenge. Segmental tracheal substitution is sometimes required to obtain radical cure. We present an experimental study of 27 dogs undergoing replacement of the cervical trachea using a vascularized small bowel segment as a tubular graft. A silicone stent was placed in the lumen of the intestinal fragment and was removed the second week after operation. Endoscopic and histological examinations were performed between the first week and second month after operation, and rigidity of the graft was assessed in all cases. No evidence of anastomotic stricture or mucous formation was found. Microscopic examination showed the substitution of bowel mucosa by squamous epithelium as well as the development of connective tissue favoring the fixation of the skeletal muscular structures of the neck to the serous layer of the graft, thus avoiding collapse of the new airway.

Hepaticothoracic transdiaphragmatic echinococcosis

Between 1970 and 1985, seven patients were referred to us for surgical treatment of simultaneous hydatid cysts in the liver and the chest. Their mean age was 45.4 years (age range, 23-73 years), and they represented 46% of patients with hydatid cysts in the liver and thorax. Three patients had hepaticopleural involvement, and 3 patients had symptoms of pulmonary origin. In a single patient, only the diaphragm was involved along with the liver. Liver scintigraphy and ultrasonography were equally helpful in delineating the extent of the disease, but computed tomographic scanning is now the method of choice. The operations were through a thoracolaparotomy in 3 patients and a thoracotomy alone in 3 patients. A single patient had a thoracotomy with a transdiaphragmatic laparotomy. Complete drainage or excision of hydatid cavities was accomplished in all patients. Hydrogen peroxide instilled into the cysts was satisfactory for control of spread potentially secondary to possible intraoperative spillage. There have been no postoperative deaths. Follow-up has ranged from 6 months to 8 years, and 2 patients had relapsing hydatid disease 3 years postoperatively. These results suggest that, when hydatid disease of the liver is complicated by transdiaphragmatic extension and simultaneous pleural or pulmonary cysts, early surgical repair is indicated. Complete drainage and cyst excision are recommended.

Mediastinoscopy as an Emergency Diagnostic Procedure in Superior Vena Cava Syndrome

Seven men and one woman (aged 20-70 years) with superior vena cava syndrome underwent diagnostic mediastinoscopy to elucidate the cause, which other, lesser procedures had not identified. Intraoperative frozen-section studies of the biopsy specimens revealed small-cell carcinoma (4 cases), large-cell carcinoma (1), squamous-cell carcinoma (1), large-cell lymphoma (1) and Hodgkins lymphoma (1). Radiotherapy or chemotherapy was initiated within the following 24 hours in six cases. One of the tumors intraoperatively diagnosed as small-cell carcinoma was subsequently reclassified as lymphocytic lymphoma. Complicating hemorrhage from the right carotid artery required median sternotomy in one case and wound infection occurred in another. There was no mediastinoscopy-related mortality. Mediastinoscopy is useful and reliable in the diagnostic emergency posed by the superior vena cava syndrome.

Candida albicans costochondritis in heroin addicts.

The dramatic increase in the number of heroin addicts has led to an increase in the number of infective complications seen, especially those due to Pseudomonas aeruginosa and Candida albicans. In this report we describe our current experience in the surgical treatment of Candida albicans costochondritis. The clinical picture, diagnostic techniques, and surgical therapy receive comment, and a brief review of the literature is given.

Seudoquistes pulmonares traumáticos

Presentamos 2 casos de seudoquistes pulmonares traumaticos (SPT) en pacientes jovenes. En ambos casos un accidente de trafico fue la causa de un traumatismo toracico cerrado y aparecieron cavidades aereas en la radiografia de torax a las 12 y una horas. En ambos casos una hemoptisis autolimitada precedio a la aparicion de un nivel hidroaereo en el control radiografico efectuado. El diagnostico se efectuo por exclusion y la evolucion fue favorable unicamente con tratamiento sintomatico y de las lesiones asociadas. Se discuten los aspectos mas importantes de la patogenia, clinica y radiologia de este tipo de lesiones.

Gammagrafía pulmonar con citrato de galio 67 en el seguimiento (recidiva/metástasis) del carcinoma broncopulmonar primitivo operado

En un grupo de 28 pacientes afectos de un carcinoma broncopulmonar primitivo de tipo no oat cell y en los que se realizo cirugia pretendidamente radical y sin radioterapia ni quimioterapia postoperatoria se efectuo seguimiento de la presunta recidiva/metastasis durante un maximo de tres anos y un minimo de seis meses mediante gammagrafia pulmonar con citrato de galio 67. Se ha demostrado que este radioisotopo tiene una mayor sensibilidad para detectar recidivas/metastasis intratoracicas en comparacion con la radiologia convencional. Durante el periodo de seguimiento doce pacientes desarrollaron recidiva/metastasis mientras que dieciseis (57%) permanecian libres de enfermedad, sin relacion con el tipo de reseccion efectuada. El torax fue el lugar mas comun de recidiva/metastasis seguido del cerebro y del esqueleto extratoracico.