Nicolás Moreno Mata

Hemangioendotelioma epiteloide pulmonar

Epithelioid hemangioendothelioma is a multifocal tumor that rarely metastasizes. It is difficult to diagnose and is most often an incidental finding in young asymptomatic women. It has a heterogeneous radiologic pattern. The most important diagnostic information is histologic confirmation of Weibel-Palade bodies or immunohistochemistry based on specific tumor markers such as factor VIII and CD34. We report the case of a 73-year-old woman in whom multiple pulmonary nodules detected by chance in a radiograph were subsequently diagnosed as epithelioid hemangioendothelioma.

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.

Normativa sobre el manejo del nódulo pulmonar solitario

The aim of the proposed recommendations is be a tool to facilitate decision-making in patients with a solitary pulmonary nodule (SPN). For an optimal decision, accessibility to the different diagnostics techniques and patient preferences need to be incorporated. The first assessment, which includes a chest computed tomography scan, separates a group of patients with extrapulmonary neoplasm or a high surgical risk who require individualized management. Another two groups of patients are patients with SPN up to 8mm and those who have a subsolid SPN, for which specific recommendations are established. SPN larger than 8mm are classified according to their probability of malignancy into low (less than 5%), where observation is recommended, high (higher than 65%), which are managed with a presumptive diagnosis of localized stage carcinoma, and intermediate, where positron emission tomography-computed tomography has high yield for reclassifying them into high or low probability. In cases of intermediate or high probability of malignancy, transbronchial needle aspiration or biopsy of the nodule may be an option. Radiologic observation with low radiation computed tomography without contrast is recommended in SPN with low probability of malignancy, and resection with videothoracoscopy in undiagnosed cases with intermediate or high probability of malignancy.

Surgery of female genital tract tumour lung metastases.

Abstract Introduction Lung metastases originating from tumors of the female genital tract are rare. Due to this rarity and their variable histology, it has been difficult to compare different patient series. Material and methods A retrospective study of patients who underwent resection of lung metastases of female genital tract tumors (uterine, fallopian and cervical cancer) during the period from 01/01/1989 to 12/31/2006. Epidemiological, diagnostic and treatment data were collected. Non-parametric tests and the survival analysis were performed using the Kaplan-Meier curves and the log-rank test. Results During the study period, 27 underwent resection. Mean disease-free interval (DFI) from initial diagnosis to the diagnosis of metastasis was 58 months (1–195 months). Mean survival from the diagnosis of metastasis was 94 months. The overall 5-year survival after diagnosis of metastasis was 84.1%. A second surgery for metastasis was performed on 5 patients (18.5%). Survival after second surgery of metastases was 80.5 months. Five-year survivals from diagnosis of metastasis were: endometrial carcinoma 100%; cervical cancer 62.5%; uterine sarcoma 60%. Adjuvant hormone therapy was prescribed in15 out of 16 patients with endometrial carcinoma. There was a statistically significant difference in survival depending on the histological type and disease free interval. Conclusion Surgical treatment of lung metastases originating from female genital tract tumors (mainly endometrial carcinoma) is associated with a high long-term survival.

Pulmonary Epithelioid Hemangioendothelioma

Epithelioid hemangioendothelioma is a multifocal tumor that rarely metastasizes. It is difficult to diagnose and is most often an incidental finding in young asymptomatic women. It has a heterogeneous radiologic pattern. The most important diagnostic information is histologic confirmation of Weibel-Palade bodies or immunohistochemistry based on specific tumor markers such as factor VIII and CD34. We report the case of a 73-year-old woman in whom multiple pulmonary nodules detected by chance in a radiograph were subsequently diagnosed as epithelioid hemangioendothelioma.

Cirugía de las metástasis pulmonares de tumores del tracto genital femenino

INTRODUCTION Lung metastases originating from tumours of the female genital tract are rare. Due to this rarity and their variable histology, it has been difficult to compare different patient series. MATERIAL AND METHODS A retrospective study of patients undergoing resection of lung metastases of female genital tract tumours (uterine and cervical cancer) during the period 01/01/1989 to 12/31/2006. Epidemiological, diagnostic and treatment data were collected. Non-parametric tests and survival analysis were performed using the Kaplan-Meier and log-rank test. RESULTS A resection was performed on 27 patients during the study period. Disease-free interval (DFI) from initial diagnosis of lung metastases was 58 months (1-195 months). The median survival from diagnosis of metastases was 94 months. The overall survival at 5 years after diagnosis of metastasis was 84.1%. A second surgery of metastases was performed on 5 patients (18.5%). Survival after second surgery of metastases: 80.5 months. Survival from diagnosis of metastasis at five years: endometrial carcinoma 100%, cervical cancer 62.5%, uterine sarcoma 60%. Adjuvant hormonal therapy was prescribed in 15 out of 16 patients with endometrial carcinoma. There was a statistically significant difference in the survival depending on the histological type and disease free interval. CONCLUSION Surgical treatment of lung metastases originating from female genital tract tumours (mainly endometrial carcinoma) is associated with a high long-term survival.

Fístula biliopleural tras la ablación con radiofrecuencia de un carcinoma hepatocelular

Fístula biliopleural tras la ablación con radiofrecuencia de un carcinoma hepatocelular Palabras clave: Radiofrecuencia hepática. Fístula biliopleural. Derrame pleural. Discusión El entusiasmo por el tratamiento de tumores hepáticos prima-rios y metastáticos mediante radiofrecuencia ha crecido en los últimos años reforzado por su eficacia y escasa morbilidad. A pesar de esto se debe conocer la posibilidad de complicaciones asociadas a esta técnica.

Inmunohistoquímica y vías de abordaje en el tumor fibroso pleural

Solitary fibrous tumor of the pleura (SFTP) is a rare, benign, slow-growing neoplasm that arises from the submesothelial cells of the pleura. Usually, resection of the tumor and adjacent structures are sufficient for resolution. Nowadays, videothoracoscopy (VTC) allows adequate access for the surgical treatment of these tumors. CD34 antigen positivity is a differential feature with mesothelioma. We present our experience with 15 patients with SFTP (nine women and six men) who underwent surgical resection in the last 12 years (10 thoracotomies, one sternotomy and four VTC). Only four patients were symptomatic at diagnosis. In our opinion, VTC is a less invasive diagnostic and therapeutic approach than thoracotomy that provides an adequate approach for the resection of SFTP in selected patients. Because of the malignant potential of this tumor, long-term follow-up is mandatory.

Reflexiones sobre la implementación del cribado mediante tomografía computarizada de baja dosis en personas con riesgo elevado de padecer cáncer de pulmón en España

Lung cancer (LC) is a major public health issue. Despite recent advances in treatment, primary prevention and early diagnosis are key to reducing the incidence and mortality of this disease. A recent clinical trial demonstrated the efficacy of selective screening by low-dose computed tomography (LDCT) in reducing the risk of both lung cancer mortality and all-cause mortality in high-risk individuals. This article contains the reflections of an expert group on the use of LDCT for early diagnosis of LC in high-risk individuals, and how to evaluate its implementation in Spain. The expert group was set up by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM).