Luis Lopez

Use of gianturco self-expandable stents in the tracheobronchial tree

Gianturco self-expandable stents were used successfully in the management of 5 patients with tracheobronchial pathology. Placement was performed under endoscopic and fluoroscopic guidance. None of the patients has experienced complications secondary to the stent placement, and in all of them the clinical problems resolved satisfactorily. Longer follow-up is required to determine the place of tracheobronchial stenting in patients with respiratory compromise.

Extended cervical mediastinoscopy: Prospective study of fifty cases☆

To assess the usefulness of extended cervical mediastinoscopy (ECM) in the staging of bronchogenic carcinoma, an ECM was performed prospectively in 50 patients with bronchogenic carcinoma of the left lung. The ECM was used after evaluation of disease operability and computed tomographic findings, and was performed simultaneously with standard cervical mediastinoscopy. In ECM, using the same cervical incision as in a standard cervical mediastinoscopy, dissection is performed behind the anterior face of the sternum. The aortic arch is reached at the level of the origin of the innominate artery. The mediastinoscope is then passed by sliding it along the left anterolateral face of the aortic arch until it reaches the aortopulmonary window. Extended cervical mediastinoscopy was considered positive when a nodal biopsy result consistent with a neoformative process or direct invasion of the mediastinal structures was found. Four patients with positive standard cervical mediastinoscopy and negative ECM were excluded. A false negative ECM was defined as the presence of infiltrated adenopathies at the paraaortic level detected on postoperative histologic study. The ECM was positive in 5 patients in whom operation was contraindicated. Resectability in the remaining 41 patients was 97.6%. Postoperative pathologic study showed infiltrated adenopathy in 3 patients (2 subcarinal, 1 subaortic) accounting for 40 true negatives (the subcarinal group is inaccessible by ECM). This study suggests that ECM has outstanding specificity (100%), sensitivity of 83.3%, and a diagnostic accuracy of 97.8%. A positive predictive value of 100% and a negative predictive value of 97.5% were also identified by this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Transbronchial fine needle aspiration in clinical practice.

We review our experience of transbronchial fine needle aspiration (TBFNA) over a 3-year period. A total of 112 TBFNAs were performed on 95 patients. Four aspirates were from peripheral lung lesions, 20 from non-ulcerated submucosal infiltrative lesions, 19 from mediastinal abnormalities close to the tracheobronchial tree, and the remaining 69 were for staging of bronchogenic carcinoma with apparent mediastinal lymph node spread, evaluated by chest computed tomography (CT). In the 20 submucosal lesions TBFNA reached a sensitivity of 82.3%, providing the only evidence of a malignant process in five cases. With respect to the 19 mediastinal lesions arising in close proximity to the central airways, TBFNA permitted a diagnosis in cases that would otherwise have required more invasive procedures, although the diagnostic sensitivity of the technique in this group of patients was poor (26%). In the mediastinal staging group, the sensitivity was 76.9%, with no false positive results. Complete sensitivity of TBFNA for the detection of disease was 65.8%. We conclude that TBFNA is a reliable and low risk procedure.

New minimally invasive technique for correction of pectus carinatum

We describe a new video-assisted operative technique for correction of pectus carinatum (PC) using a modified Nuss procedure. A new design of the steel bar was developed, so that it could be introduced and placed in a suitable position through very small skin incisions. Substantial modifications were introduced in the bar length and shape aimed at facilitating insertion and subsequent removal when required. All the surgical manoeuvres took place under direct vision using a 30° thoracoscope. Single unilateral fixation of the bar in a subpectoral pocket provided satisfactory stabilisation without the need for lateral stabilisers. Adequate correction of the deformity was achieved with minor postoperative scars. Our results support the view that minimally invasive surgical repair should be preferred over open surgery for correction of pectus carinatum in young adults and children.

Pulmonary Arteriovenous Fistula Ruptured to Pleural Cavity in Pregnancy

Congenital pulmonary arteriovenous fistula is frequently associated with hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease). With the increased blood flow in pregnancy such fistulas enlarge, occasionally giving rise to haemothorax, which generally has a poor prognosis. A familial case is presented in which massive haemothorax required emergency thoracotomy in the 27th week of pregnancy.

Surgical Treatment of Stage III Non-Small Cell Bronchogenic Carcinoma Involving the Chest Wall

Thirty-five patients who had undergone surgery for non-small cell bronchogenic carcinoma with isolated involvement of the chest wall were reviewed. The diagnosis was preoperatively suspected in 80% of cases. En-bloc resection of the invaded chest wall was performed in 25 cases and parietal pleurectomy in ten in which the pleura was easily dissectable from the costal plane. Of the eight patients with major complications in the early postoperative period, six, including the two who died perioperatively, had undergone en-block resection. The 5-year actuarial survival rate was 22% overall and 36% in the patients without lymph node involvement. No significant relationship between survival and type of operation or degree of chest wall invasion was found. Isolated involvement of the chest wall by non-small cell bronchogenic carcinoma does not necessarily contraindicate surgery with curative intent. Parietal pleurectomy is valid in selected cases. Long-term survival depends basically on node involvement.

Minimally-invasive resection of a scapular osteochondroma.

Osteochondroma of the scapula is a rare benign tumour that produces pain and mechanical dysfunction of the joint when settled on the ventral surface of the scapula. Surgical resection is the treatment of choice in symptomatic cases. Conventional open excision has been the traditional treatment of choice, while published cases involving a minimally-invasive approach are rare and restricted to descriptions of video-assisted procedures. We present a case of video-assisted surgical resection of a large osteochondroma from the ventral surface of the scapula in a young male patient with the snapping scapula syndrome. The technique and the postoperatory outcome are described.

Neumotórax espontáneo primario. Estudio retrospectivo sobre 495 casos

Con la finalidad de revisar nuestra experiencia en el tratamiento del neumotorax espontaneo primario (NEP), realizamos un estudio retrospectivo sobre los pacientes intervenidos en nuestro servicio por dicha patologia entre los anos 1986 y 1993. Los 495 casos tratados tenian edades comprendidas entre los 12 y 81 anos, con una media de 28,2. En 415 ocasiones (83,8%) fueron varones y en 80, mujeres (16,2%). En 262 se trataba de NEP derecho (52,9%) y en 215, izquierdo (43,5%). En 18 (3,6%) los episodios de NEP fueron bilaterales. El tratamiento inicial fue el drenaje pleural y se utilizaron en 85 casos drenajes de pequeno calibre. No existio morbilidad de los drenajes pleurales. La persistencia de fugas aereas, la recidiva y el sangrado agudo fueron indicaciones de tratamiento quirurgico, que se realizo en 185 ocasiones (37,3%). En 15 casos (8,1%) hubo complicaciones posquirurgicas. No existieron recidivas postoperatorias ni mortalidad. No hubo diferencias significativas en cuanto a recidivas de los drenajes convencionales y los de pequeno calibre. Tampoco las hubo en estancia media y complicaciones en la cirugia convencional y la videoasistida, de reciente introduccion. Se concluye que el NEP es una entidad que responde bien al tratamiento con drenaje pleural, constituyendo los drenajes de pequeno calibre una buena alternativa para el tratamiento de los primeros episodios de NEP. La intervencion quirurgica se indica en caso de recidiva o persistencia de fugas aereas. En la actualidad, la cirugia toracoscopica videoasistida sustituye con exito a la toracotomia axilar en la mayoria de ocasiones.

Videothoracoscopic repair of pectus excavatum with sternal transection for adult patients with nonelastic deformity

Minimally invasive repair techniques for pectus excavatum (PE) are thought to be contraindicated in patients with a rigid chest wall and to result in incomplete correction and more severe and prolonged postoperative pain for adult or late adolescent patients with a relatively malleable thorax. In these cases, additional procedures, such as osteotomy or insertion of a second bar, are required to achieve adequate correction. A new minimally invasive repair technique for PE successfully applied to patients with symmetric and rigid deformity is presented. This technique is a modification of the Nuss procedure, based on bilateral videothoracoscopic guidance and sternal transection, where the corrective bar has been modified in size and shape. Inasmuch as the involved bar is shorter and less bent than that in the original Nuss procedure, it can be inserted through minimal periareolar or submammary skin incisions with optimal cosmetic results. Sternal transection facilitates the elevation of the sternum, which results in highly satisfactory correction of the deformity and reduces the tension and pressure of the bar against the rib cage, thus potentially reducing postoperative pain.

Transcervical bedside brachiocephalic trunk clamping as a technique to reduce exsanguination from injuries to the upper right torso

From the Department of Thoracic Surgery, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Sept 17, 2015; revisions received Dec 7, 2015; accepted for publication Dec 8, 2015; available ahead of print Jan 16, 2016. Address for reprints: David Perez, MD, PhD, Department of Thoracic Surgery, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas, Spain (E-mail: dperalo@live.com). J Thorac Cardiovasc Surg 2016;151:1424-5 0022-5223/