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F Rodríguez de Castro

Publications and source records attributed to F Rodríguez de Castro.

At least 19 recordsLinked to original sources
PubMed1999

[Recurring invasive thymoma of the diaphragm].

Diaphragmatic recurrence of a thymoma is rare. We report the case of a 70-year-old woman who underwent transternal thymectomy and adjuvant radiation therapy, and who was admitted four years later with recurrence of the thymoma in the left hemidiaphragm with infiltration of the inferior ipsilateral pulmonary lobe. The thymoma was excised along with the left hemidiaphragm, chest wall and three ribs and an atypical segmentectomy of the left lower lobe was performed. The hemidiaphragm was reconstructed and the chest wall was repaired with synthetic mesh. Surgery was complemented with radiotherapy.

Aged↗
PubMed1998

[Transthoracic approach to the spinal column].

Thoracotomy is used to approach and treat anterior spinal lesions arising from various causes. Between 1990 and 1997, we treated 56 patients (40 men and 16 women) between 14 and 67 years old (mean 38.4). All had spinal lesions that were impossible or difficult to reach by a posterior approach. Thirty-one (55.3%) had suffered spinal damage, 8 (14.3%) had spinal deformities, 7 (12.5%) had metastatic tumors, 5 (8.9%) had herniated discs, 4 (7.1%) had Pott's disease and 1 (1.8%) had osteolysis at D6. Thoracotomy was left-sided in 35 cases (62.5%) and right-sided in 19 (33.9%). Video-assisted thoracoscopy was used twice (3.6%). The level of incision was based on the site of the lesion, and the pleural cavity was opened in all cases except one. The posterolateral pleuro-diaphragmatic fold was dissected and the diaphragm opened for retroperitoneal access in 37 cases (66.1%) of thoracolumbar disease. Orthopedic treatment consisted of autologous bone grafts in all cases and placement of a Kaneda splint in 32 cases (57.1%). One patient had to undergo surgery a second time due to inappropriate placement of the vertebral splint. Pneumothorax occurred in one patient after removal of pleural drains. The incision became infected in one patient, and one case of ileal paralysis was observed. Overall, morbidity was 7.1%. We conclude that thoracotomy offers a good alternative approach to spinal lesions. Results are good and morbidity low.

Adolescent↗
PubMed1997

Relevance of training in transbronchial fine-needle aspiration technique.

Transbronchial fine-needle aspiration (TBFNA) is a valuable and low-risk procedure that provides access to mediastinal nodes. To learn if increased experience improved TBFNA performance, we compared overtime TBFNA diagnostic yields between a skilled bronchoscopist and another without experience on TBFNA technique. We found higher TBFNA yields in the experienced bronchoscopist (p < 0.001); however, after some experience, the TBFNA reliability improved (p < 0.02) and the use of the procedure increased (p < 0.0001). Thus, to achieve acceptable TBFNA results, a training period is required that we estimate in about 50 procedures.

Biopsy, Needle↗
PubMed1996

Evaluation of a directly observed six months fully intermittent treatment regimen for tuberculosis in patients suspected of poor compliance.

BACKGROUND: Although a priority for tuberculosis control is to achieve the maximum cure rate, compliance with chemotherapy in specific high risk groups (homeless, intravenous drug abusers, chronic alcoholics) is usually poor. METHODS: From January 1990 to December 1994 102 patients with tuberculosis (96 pulmonary, six extrapulmonary) who were poorly compliant with treatment were treated with a six month fully intermittent (twice weekly) directly observed regimen. They comprised 71 homeless subjects, 50 chronic alcoholics, 23 intravenous drug abusers, nine infected with HIV, and 11 who had previously abandoned a daily antituberculosis regimen; 53 had more than one of these risk factors. Treatment included isoniazid and rifampicin for six months and pyrazinamide during the first two months. Patients who failed to take their medication on two consecutive occasions were actively sought by telephone or by personal search. RESULTS: After two months of treatment 95 of the 102 patients had taken their medication regularly and 90 of them had negative cultures. Four of the remaining patients had negative cultures after three months. At the end of the six months 87 patients had completed treatment and were considered cured. Only 15 patients abandoned the treatment (13 of whom had more than one risk factor). Only three relapses occurred in the 102 patients at one year follow up and in the 88 patients followed for two years. Two patients required a change of treatment due to major side effects. Although intravenous drug abuse was the only predictor of non-compliance in the multivariate analysis, if the available variables in the second month of treatment were analysed, current poor compliance and abandonment of treatment in the past were found to be significantly associated with non-compliance. CONCLUSIONS: This study shows the efficacy of this intermittent regimen and the effectiveness of a directly observed treatment programme.

Adolescent↗
PubMed1996

Comparison of bronchoscopic diagnostic techniques with histological findings in brain dead organ donors without suspected pneumonia.

BACKGROUND: The techniques for recognising pneumonia in mechanically ventilated patients were evaluated as no "gold standard" is available to establish the diagnosis in these patients. METHODS: A prospective study was performed on nine brain dead organ donors not suspected of having pneumonia to assess the specificity of bacteriological results from different samples by comparing them with the histological findings from an open pulmonary biopsy specimen taken immediately after death through a mini-thoracotomy. RESULTS: Seven of the nine organ donors without clinical evidence of pulmonary infection and not on antibiotic therapy showed histological features of bronchopneumonia. There was no association between the histological findings and quantitative cultures of the lung biopsy specimen. CONCLUSIONS: Histological evidence of pneumonia was common in this group of ventilated patients who had no clinical signs of the disease.

Adult↗
PubMed1996

Do quantitative cultures of protected brush specimens modify the initial empirical therapy in ventilated patients with suspected pneumonia?

The real contribution of the protected specimen brush (PSB) to guide the choice of antimicrobial therapy in ventilated patients with severe pneumonia is not well established. This study aimed to assess how data obtained by PSB changed the initial empirical therapy. One hundred and ten ventilated patients with suspected pneumonia were entered into a prospective study. All patients underwent fibreoptic bronchoscopy within the first 24 h after clinical suspicion of pneumonia. Specimens were obtained by PSB and were processed for quantitative cultures using standard methods. When patients were started on empirical antibiotics, a standard therapeutic regimen was followed. The decision to introduce, withdraw, maintain, or modify antibiotic therapy, according to the PSB culture results, was left to the attending physician. Pneumonia was the final diagnosis in 45 (41%) of the 110 patients. Pneumonia was excluded in 47 (43%) patients and in the remaining 18 (16%) the diagnosis was uncertain. The initial therapeutic plans were considered to be adequate in 40 patients (36%) and inadequate in 37 cases (34%). In 17 patients (15%), therapeutic changes were made based on the results of PSB cultures. In one case appropriate antibiotics were introduced; in nine cases the therapeutic regimen was reduced to select a narrower and rational therapy; and in seven patients therapy was changed because the prescribed antimicrobial agents were ineffective against the organisms recovered. This study shows that therapeutic changes were made based on the results of PSB cultures in 38% of the patients with pneumonia. In contrast, the PSB technique has no impact on antimicrobial therapy of patients without pneumonia.

Adolescent↗
PubMed1995

Surgical treatment of childhood mediastinal tuberculous lymphadenitis.

Between 1985 and 1991, we treated 6 children, aged 2 months to 3 years, who required an invasive procedure for the management of complications caused by enlarged mediastinal lymph nodes secondary to tuberculosis. Radiologic and endoscopic studies revealed bronchial involvement by lymph nodes, with endobronchial granulomas and lobar or pulmonary obstruction in 4 patients and marked tracheal and esophageal stenosis produced by extrinsic compression in the remaining 2. Pathologic study of the lymph node or bronchial samples from the 6 patients disclosed granulomas with caseous necrosis and Langhans' giant cells. All the children were treated with a standard 6-month drug regimen consisting of isoniazid, rifampicin, and pyrazinamide. Five of the patients underwent thoracotomy for the purpose of nodal curettage or excision. In 1, upper right lobectomy and bronchoplasty were necessary. The sixth patient was treated by endoscopic resection of the granulomas. There was no postoperative morbidity, and radiologic and endoscopic evidence of resolution of the lesions was observed in all the patients. In our experience, surgical treatment, when performed as a coadjuvant treatment for tracheobronchial complications stemming from mediastinal tuberculous lymphadenitis, results in the resolution of the lesions and has no related morbidity.

Bronchoscopy↗
PubMed1995

The epidemiology of tuberculosis in Gran Canaria, Canary Islands, 1988-92: effectiveness of control measures.

SETTING: Since there is no national programme for tuberculosis control in Spain and the epidemiological situation in this country is unknown, a programme against tuberculosis in Gran Canaria (Canary Islands) was started in 1987. OBJECTIVE: To analyze the impact of this control programme, particularly the trend of new cases of tuberculosis by age groups and risk factors for 1988-92. DESIGN: A detailed search of all new cases of tuberculosis was carried out by examining the files of all public and private hospitals and outpatient clinics of the island, the records of the Services of Clinical Microbiology and Pathology of the public hospitals, and the registers of patients with AIDS. RESULTS: The annual rates of new cases of tuberculosis per 100,000 were 32.2 in 1988 (214 cases), 26.2 in 1990 (174 cases), and 29.4 in 1992 (196 cases), and the rates of sputum-positive cases 13.3 (89 cases), 12 (80 cases) and 15 (100 cases), respectively. The distribution of tuberculosis cases by age peaked in the age groups 40-49 and 30-39 years. Between 1988 and 1992, statistically significant differences were found in the percentage of cured patients (21% [45/214] vs 85.7% [168/196]), patients with a delay in diagnosis > 3 months (40.2% [86/214] vs 21.9% [43/196]), and contacts evaluated (45.3% [97/214] vs 90.3% [177/196]). However, an upward trend in the incidence of tuberculosis for 1990-92 was found in association with an increase of new cases among the homeless, immigrants, and HIV-infected people. When these three population groups were excluded from the analysis, the annual rate for the total population showed a progressive decline from 1988-92. CONCLUSIONS: The data studied here show that successful priority control measures (cure rate, early diagnosis, study of contacts) have been achieved in this island. It is necessary, however, to develop strategies for combating the tuberculosis problem in specific high risk populations.

Adolescent↗
PubMed1995

[Traumatic hemothorax treated by video-assisted thoracoscopic surgery].

The introduction of video-assisted thoracic surgery (VTS) has significantly furthered the use of the thoracoscope in surgery. In the case we describe, a 79-years-old man at high risk for surgery came to our hospital with hemothorax due to trauma. The necessary procedure was performed successfully with VTS, which allowed for the repair of an acute condition that would otherwise have been treated conventionally by way of posterolateral thoracotomy. We conclude that VTS may play an important role in the diagnosis and treatment of certain thoracic injuries, so that surgery involving more extensive bleeding is rendered unnecessary.

Accidental Falls↗
PubMed1995

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.

Adolescent↗
PubMed1995

DNA analysis of bronchoalveolar lavage in the diagnosis of pulmonary lymphoma.

Lung lymphomas frequently present a diagnostic challenge. The diagnosis of malignant lymphoma is possible when lymphocyte subpopulations show aneuploidy or a definable monoclonal surface marker or both. We present a case of lymphoma of the lung in which DNA analysis of bronchoalveolar lavage fluid was the first successful method in the time course of diagnosis.

Aged↗
PubMed1994

[The efficacy of bronchoalveolar lavage in the diagnosis of pulmonary tuberculosis].

In order to analyze the usefulness of bronchoalveolar lavage (BAL) for conventional microbiological diagnosis of tuberculosis (TB) and other mycobacteria, and to assess the need to use it or not as a routine diagnostic technique in these diseases, we studied 30 patients with mycobacteria (26 TB and 4 Mycobacterium avium-intracellulare infections) by bronchoscopy, with BAL and bronchoaspirate (BAS) bacteriological analyses also available. The results were compared with those obtained for sputum taken before and after bronchoscopy when these specimens were available. The overall yield for BAL and BAS cultures was 90%, with BAL (83.3%) specimens being more productive than BAS (73.3%) specimens. Both performed far better than the 53.8% recorded for cultures of pre-bronchoscopy sputum and 60% for post-bronchoscopy sputum. BAL was the only diagnostic specimen from 7 patients, while BAS the only one from 4. Sensitivity was similar for the two mycobacteria studied. The results for direct bacilloscopy, however, at 30% for the two specimens, rose to 36.6% when they were analyzed together with BAS and BAL. We conclude that bronchoscopy should be performed on all patients suspected of mycobacterial infection when sputum bacilloscopy is negative and patients have no expectoration. Performance of BAL should be routine since this simple and usually uncomplicated technique produces the most productive specimens.

Adolescent↗