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Objective: To review the complications associated with the minimally invasive retropleural approach used in the anterior approach to the thoraco-lumbar spine., Material and Method: We present the MIS surgical technique and the evaluation of data collected prospectively from the initial series of 31 patients undergoing surgery. Pleural opening during the approach, lung complications derived, other surgical complications, time of intervention, intraoperative bleeding, need for transfusion and hospital stay are evaluated., Discussion: The mean age of the patients was 58years, the surgical time 225min, and the bleeding 274ml, with a 13% postoperative transfusion. Intraoperatively, pleural opening was detected in 8 cases, of which none had major pulmonary complications during the postoperative period. There were 3 cases of mild pleural effusion, all patients without pleural opening, and one case of haemopneumothorax due to intercostal vessel bleeding that required reoperation. The percentage of intercostal neuralgia was 3%. The mean hospital stay was 6.7days, and 24 of 31 patients were able to initiate early mobilization on the first postoperative day., Conclusions: The retropleural approach allows the surgical treatment of pathologies requiring anterior access to the thoraco-lumbar spine, with a low profile of pulmonary complications, and with the advantages of minimally invasive techniques in terms of less bleeding, early recovery and shorter hospital stay. Nevertheless the learning curve is long., (Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Prolonged air leak after pleural decortication is one of the most frequent complications., Objective: The aim of this study is to compare the effects of prolonged air leak between the digital chest drainage (DCD) system and the classic drainage system in patients with empyema class IIB or III (American Thoracic Society classification) in pleural decortication patients., Material and Methods: A total of 37 patients were enrolled in a prospective randomized control trial over one year, consisting of 2blinded groups, comparing prolonged air leak as a main outcome, the number of days until removal of chest drain, length of hospital stay and complications as secondary outcomes., Results: The percentage of prolonged air leak was 11% in the DCD group and 5% in the classic group (P=0.581); the mean number of days of air leak was 2.5±1.8 and 2.4±2.2, respectively (P=0.966). The mean number of days until chest tube removal was 4.5±1.8 and 5.1±2.5 (P=0.41), the length of hospital stay was 7.8±3.7 and 8.9±4.0 (P=0.441) and the complication percentages were 4 (22%) and 7 (36%), respectively (P=0.227)., Discussion: In this study, no significant difference was observed when the DCD was compared with the classic system. This was the first randomized clinical trial for this indication; thus, future complementing studies are warranted., (Copyright © 2016 Academia Mexicana de Cirugía A.C. All rights reserved.)

There are three major challenges in the diagnosis of malignant pleural mesothelioma: mesothelioma must be distinguished from benign mesothelial hyperplasia; malignant mesothelioma (and its subtypes) must be distinguished from metastatic carcinoma; and invasion of structures adjacent to the pleura must be demonstrated. The basis for clarifying the first two aspects is determination of a panel of monoclonal antibodies with appropriate immunohistochemical evaluation performed by highly qualified experts. Clarification of the third aspect requires sufficiently abundant, deep biopsy material, for which thoracoscopy is the technique of choice. Video-assisted needle biopsy with real-time imaging can be of great assistance when there is diffuse nodal thickening and scant or absent effusion. Given the difficulties of reaching an early diagnosis, cure is not generally achieved with radical surgery (pleuropneumonectomy), so liberation of the tumor mass with pleurectomy/decortication combined with chemo- or radiation therapy (multimodal treatment) has been gaining followers in recent years. In cases in which surgery is not feasible, chemotherapy (a combination of pemetrexed and platinum-derived compounds, in most cases) with pleurodesis or a tunneled pleural drainage catheter, if control of pleural effusion is required, can be considered. Radiation therapy is reserved for treatment of pain associated with infiltration of the chest wall or any other neighboring structure. In any case, comprehensive support treatment for pain control in specialist units is essential: this acquires particular significance in this type of malignancy., (Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.)

Extrahepatic complications from hepatic cystic echinococcosis are rare and may be life threatening. Although the prevalence of echinococcosis in Spain had decreased, the number of cases of this disease and its severity has risen again due to immigration. We report the case of a patient with a giant hepatic echinococcus cyst diagnosed during investigation of an abdominal mass. The mass was associated with three other cysts: the first cyst was fistulized to the biliary tract, without clinical or laboratory alterations, the second cyst was fistulized to the right pleural cavity, leading to pleural echinococcosis and respiratory distress due to massive pleural effusion, and the third cyst was calcified. The challenge in this case layed in its diagnosis and treatment. The clinical presentation was unusual due to the extension of the disease, hampering complete cystic excision.

Surgical resection of pulmonary metastasis is appropriate provided the general principals of oncological surgery are followed. Complete excision of the metastatic tumor is associated with long-term survival and low perioperative mortality. We present 2 cases of single pulmonary metastasis from osteosarcoma with cardiac involvement. In both cases, complete excision required left pneumonectomy by sternotomy with extracorporeal circulation. The outcomes were favorable, no perioperative complications were reported, and the patients remained free of disease at 14 and 17 months after surgery. In conclusion, we believe that the cases presented confirm that extended pneumonectomy with extracorporeal circulation if necessary is a valid approach for complete resection of pulmonary metastasis.

Introduction: Ventriculoatrial and ventriculopleural shunts (VPS) are alternatives to ventriculoperitoneal shunts for draining cerebrospinal fluid from patients with hydrocephalus. VPS has seldom been used because of the risk of respiratory insufficiency due to pneumothorax or pleural effusion. However, valves are currently available with anti-siphon devices for use with standard shunting systems to prevent the development of pleural effusion. The aim of this study was to analyze outcome after VPS in eight patients in whom we used the new valves for avoiding overdrainage of cerebrospinal fluid., Material and Method: Nine VPS procedures were performed in eight hydrocephalic patients between 1988 and 2000. We used differential pressure valves in eight procedures and a flow regulator valve in one. The externally adjustable Sophy valve was used in six cases. The indication for VPS was peritoneal adhesions in four cases, persistent ascites in two, ventriculoatrial valve obstruction in one, and infection of the peritoneal shunt (peritonitis) in one. The ninth case involved replacement of a previously obstructed valve., Results: After a follow-up period of 22 months all shunts were functioning well and the only patient with symptoms of hydrocephalus was the one who required valve replacement at six months. No surgical morbidity or mortality was observed, and only one patient developed transitory signs of excessive cerebrospinal fluid drainage, which was corrected by regulating the magnetic valve gradient. The death of one patient 36 months after surgery was unrelated to pleural drainage., Conclusions: Valves newly designed to prevent overdrainage of cerebrospinal fluid give satisfactory results, such that VPS should be considered as an alternative to peritoneal drainage.

Seven cases of solitary fibrous tumours of the pleura are here reported, formerly named benign fibrous mesotheliomas. Histologically, these tumours are formed by fusiform cells with a minimal cellular pleomorphism and absence of mitosis. These tumours cause scarce symptoms which are usually diagnosed as a casual finding when a chest X-ray is performed on account of other cause. Treatment should be surgical, with removal of all tumoral mass, thus avoiding its growth and the possibility of the reported degeneration towards malignancy.

Benign fibrous or pleural mesothelioma are rare tumors that seem to originate in the mesenchyma (subpleural fibromas). They are usually discovered by chance and the prognosis for the patient is favorable after surgery. If the tumors are large, extrapulmonary signs may be present (hypertrophic osteoarthropathy, hypoglycemia). We describe a case of unusually large fibrous mesothelioma of the pleura that presented as superior vena cava syndrome, a complication not described in the literature.

The methods used to induce pleural symphisis in recidivant malignant pleural effusions are reviewed. The most suitable for an average hospital are the intrapleural introduction of talc and tetracycline clorhydrate, of which the procedures are described.

The authors emphasize on the importance of histologic study of the sick pleura to obtain a diagnosis and to decide the treatment, operative or not, which must be specific. They choose the surgical biopsy and analyze the results obtained in 104 operations performed on 100 patients. Four groups of lesions are established: 1) malignant tumors (primary and secondary), 2) Non specific pleuritis consecutive to carcinoma of the lung or other organs, usually metastatic from the breast or the digestive tract, 3) Non specific pleuritis, and 4) Tuberculosis. Cancer or tuberculosis are found in pleurisies of different types. Cancer was found in a 43,7% of the serous pleurisies, in a 64% of the seroushemorrhagic, and in a 46% of the hemorrhagic pleurisies. Tuberculosis was found in a 15,6 % of the serous, in a 7,14 % of the seroushemorrhagic and in a 15,7 % of the purulent. In one case of hemorrhagic pleurisy in which the diagnosis of tuberculosis was not made, further studies confirmed it. The authors point to the existence of non specific pleuritis without neoplastic infiltration in some pleurisies consecutive to lung tumors or from other organs and to its therapeutic consequences. They also inform having found tuberculosis in patients over 50 years of age (8 in 11 cases). In this series the youngest pleural cancer case was a 27 years old man.