Search

Fundamento Existen varias opciones terapeuticas para los pacientes con un primer episodio de neumotorax espontaneo idiopatico. El objetivo de este estudio es comparar la efectividad de dos alternativas de tratamiento, la puncionaspiracion con cateter fino y el drenaje pleural grueso. Pacientes y metodos Comparamos una serie actual de 91 pacientes tratados con puncion-aspiracion con una serie historica de 216 casos tratados con drenaje pleural grueso. La puncion-aspiracion fue realizada por los medicos de los servicios de urgencias hospitalarias y el drenaje pleural grueso por cirujanos toracicos. Se siguio a los pacientes tras el tratamiento durante un periodo de 24 meses. Resultados La efectividad inmediata de la puncion-aspiracion fue superior al drenaje pleural grueso (el 86,7 frente al 76%; p Conclusiones La puncion-aspiracion es una maniobra terapeutica tan efectiva como el drenaje pleural grueso. Se trata de un procedimiento sencillo, que los medicos de los servicios de urgencias hospitalarias pueden realizar correctamente. Las incomodidades para el paciente, el coste sanitario y el tiempo de ingreso se reducen de forma notable.

La hernia pulmonar o neumocele es una protrusion del pulmon a traves de un defecto de la pared toracica. Presentamos un caso de hernia pulmonar intercostal espontanea y realizamos una descripcion de la patogenia y de la clasificacion de las hernias pulmonares. Se discuten los hallazgos clinicos y radiologicos, asi como los diferentes metodos de tratamiento. En este caso, el paciente presento un intenso dolor toracico en la base del hemitorax izquierdo. Las imagenes obtenidas por radiografia simple y tomografia axial computarizada (TAC) toracicas pusieron de manifiesto la existencia de una hernia intercostal izquierda. Despues del diagnostico radiologico se realizo tratamiento quirurgico reparador con buenos resultados.

In pulmonary hernia or pneumocele the lung protrudes through a defect in the chest wall. In this report of a case of spontaneous intercostal lung hernia, we describe the pathogenesis and classification of such hernias, including signs, symptoms, radiological findings and treatment methods. Our patient presented with severe chest pain at the base of the left hemithorax. A chest film and computed tomography of the region showed an left intercostal hernia. Surgical treatment was successful.

Several options are available for treating patients with a first episode of primary spontaneous pneumothorax (ISP). The aim of this study was to compare the efficacy of two treatment alternatives: puncture-aspiration (PA) using a small caliber catheter, and pleural drainage through a chest tube (DCT).We compared a current series of 91 patients treated with PA with a retrospective series of 216 patients treated with DCT. PA was performed by emergency room physicians and DCT was performed by chest surgeons. Patients were followed for a period of 24 months.The immediate efficacy of PA was superior to DCT (86.7% versus 76%, p0.05). The proportion of recurrences after each treatment was similar (23% and 17%, respectively, NS). Duration of hospital stay was shorter for PA-treated patients (24 h) than for DCT-treated patients (138 h) (p0.05). The efficacy of the two procedures 24 months later was similar (63.7% and 62.9%, respectively, NS), and the cost of PA was three times less than that of DCT.PA is as effective a treatment procedure as DCT. PA is simple enough for emergency room physicians to perform correctly. Inconvenience to the patient, cost to the health care system, and time of hospital stay are all significantly less with PA.