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Resumen Introduccion La reseccion videotoracoscopica (VTC) de los nodulos pulmonares (NP) perifericos requiere en ocasiones la practica de una minitoracotomia para su localizacion mediante palpacion. El objetivo de este estudio es evaluar la eficacia como metodo de localizacion preoperatoria de los NP de la colocacion de un arpon guiado por TAC. Material y metodos Desde noviembre de 2004 hasta enero de 2011, 52 pacientes fueron programados para localizacion preoperatoria de 55 NP mediante la colocacion de un arpon guiado por TAC. Resultados Un total de 52 pacientes (31 hombres y 21 mujeres) con edades entre 28 y 84 anos (media: 62,2 anos) con NP Conclusiones La identificacion preoperatoria de los NP permite su reseccion VTC directa. La colocacion de un arpon guiado por TAC en los NP constituye un procedimiento seguro y efectivo que puede llevarse a cabo en un programa de cirugia ambulatoria.

Surgical therapy plays an important role in the management of selected patients with metastatic melanoma. A retrospective review of 13 patients who underwent surgical resection of lung metastases from melanoma from 1996 to 2003 was performed. The aim of the study was to analyze the clinical outcome and survival time. Mean age was 45 years old (range: 31-64). Complete tumour resection was confirmed histologically. Nine patients presented one single pulmonary lesion, two lesions (n = 3) and three lesions (n = 1) but in all cases confined in the same pulmonary lobe. Median survival time (MST) for the entire group was 20 months (95% confidence interval (CI): 16-24 months). The median time to disease progression after lung metastasectomy was 5 months (95% CI: 3-7 months). MST, according to the prognostic groups proposed by the International Registry of Lung Metastases, was 17 months (95% CI: 6-28 months) for group I (n = 6), MST of 20 months (95% CI: 16-24 months) for group II (n = 5) and MST of 4 months for group III (n = 2), without differences statistically significant ( log-rank p = 0.423). MST regarding the time of disease free interval from diagnostic of primary tumour and lung metastases ( 36 months [n = 8]) was 20 months and 17 months respectively, without differences statistically significant ( log rank p = 0.222). Surgical resection when feasible provides survival rates superior to any available nonsurgical therapy. In carefully selected patients, when the resection is performed with curative intent, it may result in improved survival.

The progress that has been made in patient selection, minimally invasive surgery, anesthesia (both in surgery and in the control of postoperative pain), and antibiotic treatments have substantially improved the morbility and mortality associated with the surgical treatment of bronchogenic carcinoma in recent years. Nevertheless, the rate of major complications after lung cancer resection is 2% to 22%, and the mortality rate is 2% to 7%. The most frequent complications after lung cancer resection are of respiratory origin. The most serious ones are pneumonia and acute respiratory distress syndrome, and they are also the main causes of death in this period. They also share similar clinical and evolutionary features that can make it difficult to distinguish between them. The incidence of pneumonia after a lung cancer resection is 2% to 20%, and the mortality in patients that develop pneumonia is significantly higher than in other patients. It is also the cause of death in 22% to 67% of cases after lung resection. Therefore, patients with lung cancer treated with lung resection comprise a population with a high risk of experiencing pneumonia with a serious prognosis. Apart from being one of the main factors that determine short-term survival, postoperative pneumonia prolongs the hospital stay and involves a significant consumption of resources (antibiotics, stay in intensive care unit). For all these reasons, there is growing interest in identifying the factors associated with the risk, prevention, diagnosis, and treatment of respiratory infections after lung cancer resection.

Resumen La recurrencia de la neoplasia pulmonar en el arbol bronquial tras una reseccion pulmonar es dificil de diagnosticar antes de que la enfermedad progrese. El objetivo del presente estudio es determinar la incidencia de la recidiva asintomatica endobronquial tras la cirugia por carcinoma broncogenico y evaluar la utilidad de la fibrobroncoscopia en el diagnostico precoz de dicha recidiva. Entre enero de 1994 y agosto de 1998 practicamos 150 fibrobroncoscopias en 121 pacientes a los que se habia practicado antes una reseccion pulmonar con intencion curativa por un carcinoma broncogenico. La fibrobroncoscopia se indico por la presencia de alteraciones clinicorradiologicas o como control postoperatorio en pacientes asintomaticos. El tiempo medio transcurrido desde la cirugia hasta la fibrobroncoscopia fue de 19,79 meses (DE = 20,8 meses). Se detectaron 21 recidivas neoplasicas (17,8%), cuatro en el munon de reseccion bronquial y 17 en otras regiones del arbol bronquial. Diez pacientes estaban asintomaticos en el momento del diagnostico de la recidiva (8,5%). Las recidivas endobronquiales asintomaticas se presentaron en un periodo medio de tiempo de 16,3 meses (DE = 4,75 meses). Debido al riesgo de padecer una recidiva en este periodo de tiempo, creemos que es conveniente practicar sistematicamente una fibrobroncoscopia a los 18 meses de la reseccioquirurgica n. Los pacientes con un diagnostico precoz de recidiva podrian, sino mejorar su supervivencia, si mejorar su calidad de vida con terapeuticas coadyuvantes (Nd YAG laser, quimioterapia y/o radioterapia).

Resumen Analizamos de manera retrospectiva a 33 pacientes afectados de tumores malignos primarios de la pared toracica, intervenidos quirurgicamente entre enero de 1985 y enero de 2002. Valoramos los resultados de la tecnica quirurgica utilizada, la recurrencia tumoral y la supervivencia de los pacientes. En todos los casos se realizo una reseccion en bloque de la lesion con pretension radical. Se efectuaron 39 resecciones de pared toracica. El numero de arcos costales resecados oscilo entre dos y cinco (media, 2,6). En 27 casos fue necesario reconstruir la pared toracica con protesis de material sintetico, y en cinco de ellos se llevo a cabo, ademas, una mioplastia (cuatro injertos pediculados de musculo dorsal ancho y uno de musculo pectoral mayor). En 6 casos se realizo, ademas, una esternectomia parcial. El seguimiento medio de los pacientes fue de 45,6 meses (rango 3-140 meses). Once pacientes fallecieron a causa del tumor. Los 14 pacientes intervenidos de condrosarcoma tuvieron un seguimiento medio algo inferior (41,5 meses); diez de estos enfermos se hallan actualmente libres de enfermedad y dos han fallecido a consecuencia de la progresion tumoral. La supervivencia actuarial (Kaplan-Meier) a los 5 anos de los pacientes con condrosarcoma (n = 14) fue del 75 ± 21%. El resto de pacientes, exceptuando las fibromatosis agresivas (tumor desmoide) y el paracordoma (n = 14), tuvieron una supervivencia actuarial a los 5 anos del 26 ± 10%.

Videothoracoscopic (VTC) resection of peripheral pulmonary nodules (PN) occasionally requires performing a mini-thoracotomy to locate them using palpation. The aim of this study is to evaluate the usefulness of inserting a CT-guided harpoon as a method for locating PN prior to surgery.A study was conducted on a total of 52 patients who were scheduled for locating 55 PN prior to surgery by inserting a CT-guided harpoon, from November 2004 to January 2011.Of the 52 patients, of whom 35 had a history of cancer, 31 were male and 21 were female, with ages between 28 and 84 years (mean: 62.2 years) with a PN 20mm (mean: 9.57mm). A total of 55 harpoons were inserted (3 patients had 2 simultaneous harpoons). Using the VTC it was observed that 52 harpoons were correctly anchored to the PN. There were no complications. In the group of 35 patients with an oncology history, the nodules were malignant in 26 cases (74.3%), and there were 17 (70.6%) with malignant PN in those with no oncology history. The hospital stay varied between 4 and 72h, with 19 patients (36.5%) included in a one-day surgery program.The preoperative identification of peripheral pulmonary nodules enables them to be removed directly with VTC. The insertion of a CT-guided harpoon in the PN is a safe and effective procedure that can be performed in a one-day surgery program.

1010-7940/$ see front matter Q 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.ejcts.2005.02.011 * Corresponding author. Address: Department of Thoracic Surgery, Hospital Clinico, C/Villarroel, 170, 08036 Barcelona, Spain. Tel.: C34 93 2275400; fax: C34 93 2279380. E-mail address: toracica@hotmail.com (M. Iglesias). bronchus. The object was removed and tracheal inflammation and chordal oedema were seen. The patient was discharged at 24 h after procedure without incidences (Fig. 1). European Journal of Cardio-thoracic Surgery 27 (2005) 1112 www.elsevier.com/locate/ejcts

Adapting a silicone tracheal safe T-tube is a simple method to guarantee upper airway permeability. Its making and availability ease offers a cheap and valid option to avoid the complications of the tracheostomy tube.

A technique for simultaneous cardiac operation and pulmonary resection via a small upper midline sternotomy is described. It was employed in a 62-year-old man undergoing aortic valve replacement and right lower lobectomy for a carcinoid tumor.

The dramatic increase in the number of heroin addicts has led to an increase in the number of infective complications seen, especially those due to Pseudomonas aeruginosa and Candida albicans. In this report we describe our current experience in the surgical treatment of Candida albicans costochondritis. The clinical picture, diagnostic techniques, and surgical therapy receive comment, and a brief review of the literature is given.