Juan José Rivas de Andrés

Guidelines for the Diagnosis and Treatment of Spontaneous Pneumothorax

This is the fourth update of the guidelines for the diagnosis and treatment of pneumothorax published by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Spontaneous pneumothorax, or the presence of air in the pleural space not caused by injury or medical intervention, is a significant clinical problem. We propose a method for classifying cases into 3 categories: partial, complete, and complete with total lung collapse. This classification, together with a clinical assessment, would provide sufficient information to enable physicians to decide on an approach to treatment. This update introduces simple aspiration in an outpatient setting as a treatment option that has yielded results comparable to conventional drainage in the management of uncomplicated primary spontaneous pneumothorax; this technique is not, as yet, widely used in Spain. For the definitive treatment of primary spontaneous pneumothorax, the technique most often used by thoracic surgeons is video-assisted thoracoscopic bullectomy and pleural abrasion. Hospitalization and conventional tube drainage is recommended for the treatment of secondary spontaneous pneumothorax. This update also has a new section on catamenial pneumothorax, a condition that is probably underdiagnosed. The definitive treatment for a recurring or persistent air leak is usually surgery or the application of talc through the drainage tube when surgery is contraindicated. Our aim in proposing treatment algorithms for the management of pneumothorax in these guidelines was to provide a useful tool for clinicians involved in the diagnosis and treatment of this disease.

Recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas

Felipe Villar Álvareza,*,1, Ignacio Muguruza Truebab,1, José Belda Sanchisc, Laureano Molins López-Rodód, Pedro Miguel Rodríguez Suáreze, Julio Sánchez de Cos Escuínf, Esther Barreirog, M. Henar Borrego Pintadoh, Carlos Disdier Vicentei, Javier Flandes Aldeyturriagaj, Pablo Gámez Garcíak, Pilar Garrido Lópezl, Pablo León Atancem, José Miguel Izquierdo Elenan, Nuria M. Novoa Valentíno, Juan José Rivas de Andrésp, Íñigo Royo Crespop, Ángel Salvatierra Velázquezq, Luis M. Seijo Maceirasr, Segismundo Solano Reinas, David Aguiar Bujandat, Régulo J. Ávila Martínezk, José Ignacio de Granda Oriveu, Eva de Higes Martínezv, Vicente Díaz-Hellín Gudek, Raúl Embún Florp, Jorge L. Freixinet Gilarte, María Dolores García Jiménezm, Fátima Hermoso Alarzak, Samuel Hernández Sarmientot, Antonio Francisco Honguero Martínezm, Carlos A. Jiménez Ruizw, Iker López Sanzn, Andrea Mariscal de Albak, Primitivo Martínez Vallinap, Patricia Menal Muñozx, Laura Mezquita Pérezl, María Eugenia Olmedo Garcíal, Carlos A. Rombolám, Íñigo San Miguel Arreguiy, María del Valle Somiedo Gutiérrezj, Ana Isabel Triviño Ramírezm, Joan Carles Trujillo Reyesc, Carmen Vallejoz, Paz Vaquero Lozanos, Gonzalo Varela Simóo y Javier J. ZuluetaaaThe Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.

Morbidity and mortality in a large series of surgical patients with pulmonary metastases of colorectal carcinoma: a prospective multicentre Spanish study (GECMP-CCR-SEPAR)

OBJECTIVE Little information is available on postoperative morbidity and mortality after pulmonary metastasectomy. We describe the postoperative morbidity and mortality in a large multicentre series of patients after a first surgical procedure for pulmonary metastases of colorectal carcinoma (CRC) and identify the pre- and intraoperative variables influencing the clinical outcome. METHODS A prospective, observational and multicentre study was conducted. Data were collected from March 2008 to February 2010. Patients were grouped into Groups A and B according to the presence or absence of postoperative complications. Variables in both groups were compared by univariate and multivariate analyses. P-values of <0.05 were considered statistically significant. RESULTS A total of 532 patients (64.5% males) from 32 hospitals were included. The mean (SD) ages of both study groups were similar [68 (10) vs 67 (10) years, P = NS). A total of 1050 lung resections were performed (90% segmentectomies or wedge, n = 946 and 10% lobectomies or greater, n = 104). Group A included 83 (15.6%) patients who developed a total of 100 complications. These included persistent air leaks in 18, atelectasis in 13, pneumonia in 13, paralytic ileum in 12, arrhythmia in 9, acute respiratory distress syndrome in 4 and miscellanea in 31. Reoperation was performed in 5 (0.9%) patients due to persistent air leaks in 4 and lung ischaemia in 1. The mortality rate was 0.4% (n = 2). Causes of death were sepsis in 1 patient and ventricular fibrillation in 1. In the multivariate analysis, lobectomy or greater lung resection [odds ration (OR) 1.9, 95% confidence interval (95% CI) 1.04-3.3, P = 0.03], respiratory co-morbidity (OR 2.3, 95% CI 1.1-4.6, P = 0.01) and cardiovascular co-morbidity (OR 2, 95% CI 1-3.8, P = 0.02) were independent risk factors for postoperative morbidity. Video-assisted surgery vs thoracotomy showed a protective effect (OR 0.3, 95% CI 0.1-0.8, P = 0.01). CONCLUSIONS The first episode of lung surgery for pulmonary metastases of CRC was associated with very low mortality and reoperation rates (<1%). The postoperative morbidity rate was 16%. Independent risk factors of postoperative morbidity were major lung resection and respiratory and/or cardiovascular co-morbidity. Video-assisted surgery showed a protective effect.

Sumario ejecutivo de las recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas

The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.

Normativa sobre Cirugía del Sistema Nervioso Simpático Torácico

Thoracic sympathetic nervous system (TSNS) surgery has increased in importance in the last few years, generating great expectations among the general population and the scientific community. This has been due to the excellent results obtained by videothoracoscopy-assisted thoracic sympathectomy in the treatment of essential hyperhidrosis and other TSNS disorders. This minimally invasive surgical technique has been shown to be effective, and with a low morbidity it is accepted as one of the best therapeutic options for the treatment of palmar and bilateral axillary hyperhidrosis and the number of patients consulting with the intention of having the operation has increased considerably. Although compensatory sweating, which is occasionally intense, often occurs after the surgery, this and other secondary effects of the technique are well tolerated by patients. The current evidence on TSNS and the treatment of essential hyperhidrosis is based on observational studies, making it difficult to compare series and draw conclusions. There has been much discussion on standardising the technique, defining the most favourable levels for clipping, and choosing the type of denervation with least secondary effects. This has led to the need to draw up these guidelines which should clarify and standardise the criteria for managing patients with disorders of TSNS.

Guidelines on Surgery of the Thoracic Sympathetic Nervous System

Abstract Thoracic sympathetic nervous system (SNS) surgery has increased in importance in recent years, generating great expectations among the general population and the scientific community. This has been due to the excellent results obtained by video-assisted thoracic sympathectomy in the treatment of essential hyperhidrosis and other thoracic SNS disorders. This minimally invasive surgical technique has been shown to be effective and to have low morbidity. It is accepted as one of the best therapeutic options for the treatment of palmar and bilateral axillary hyperhidrosis, and the number of patients interested in undergoing the procedure has increased considerably. Although compensatory sweating, which is occasionally intense, often occurs after the surgery, this and other side effects of the technique are well tolerated by patients. The current evidence on thoracic SNS and the treatment of essential hyperhidrosis is based on observational studies, making it difficult to compare series and draw conclusions. There has been much discussion on standardizing the technique, defining the most favorable levels for clipping, and choosing the type of denervation with the least amount of side effects. This has led to the need to draw up these guidelines which should clarify and standardize the criteria for managing patients with thoracic SNS disorders.

Schwannoma del nervio vago intratorácico

Neurogenic tumors represent approximately 20% of all mediastinal neoplasms in adults.1 Anatomically, they can derive from the nerve sheath, the ganglion cells or from the paraganglion system. The majority are benign tumors and are located in the posterior mediastinum at the level of the paravertebral gutter, coming from the root of either an intercostal or sympathetic nerve.2 Only between 4% and 6% originate in the visceral compartment from the nerve sheaths of the vagus or phrenic nerves.3 We present the case of a 53-year-old male with a personal history of HTN and right peripheral facial paralysis for the last 2 years. In the study for a possible myopathy, simple chest xray revealed a posterior mediastinal mass, and the patient was referred to our department. The study of the patent was completed with thoracic CT that confirmed a mass measuring 63 × 57 mm that was hypodense, walled and localized in the posterior mediastinum (Fig. 1). It was causing compression and a displacement of the lumen of the lower third of the esophagus and of the posterior

Carcinoide tímico asociado a síndrome de neoplasia endocrina múltiple tipo I

Thymic carcinoids are a rare entity that may be associated with endocrine diseases like Cushings syndrome or multiple endocrine neoplasia syndrome type I (MEN1). These tumors represent 4% of anterior mediastinal tumors and are characterized by their very aggressive behavior. We present the case of a patient with a previous MEN 1 diagnosis in whom, during the follow up of his disease, a thoracic image compatible with thymic carcinoid was detected. After an extended thymectomy that included peri-thymic fat resection, the clinical diagnosis was confirmed. A follow up examination 14 months later revealed a suspicious lesion that suggested local recurrence, therefore the patient was reoperated on. The pathology report of this surgery indicated post-radiation fibrosis. Likewise, we present a review of the current diagnostic and therapeutic management of patients with MEN1 syndrome who are diagnosed with thymic carcinoid.

Tumor del seno endodérmico primario de pulmón. Una rara entidad anatomopatológica

The most frequent location for non-metastatic germ cell tumors is the anterior mediastinum. Primary lung germ cell tumors are an exception in medical literature being limited to just a few cases of choriocarcinomas and rare cases of yolk-sac tumors. In this paper, we report a case of a pulmonary yolk-sac tumor with atypical characteristic as regards its diagnosis and treatment.

Pulmonary Pure Yolk-Sac Tumor. A Rare Anatomopathological Entity

Abstract The most frequent location for non-metastatic germ cell tumors is the anterior mediastinum. Primary lung germ cell tumors are an exception in the medical literature, limited to just a few cases of choriocarcinomas and rare cases of yolk-sac tumors. In this paper, we report a case of a pulmonary yolk-sac tumor with atypical characteristics of diagnosis and treatment.