[Surgical treatment of spontaneous pneumothorax].
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Biomedical subjects
Publications and source records attributed to J Torres Lanzas.
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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.
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We describe a 41-year-old patient with adult-onset dermatomyositis who developed persistent pneumomediastinum and severe subcutaneous emphysema due to end-stage interstitial lung disease. The diagnosis of dermatomyositis was based on proximal muscle weakness, electromyographic findings of inflammatory myopathy, and positive findings on muscle biopsy. Low levels of creatine kinase elevation were found at the time of diagnosis (a form of dermatomyositis which has been associated with a poor prognosis). The patient had no signs of cutaneous vasculitis. Despite treatment with prednisone and azathioprine, she died of intercurrent gram-negative sepsis 15 months after the diagnosis of dermatomyositis.
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Aspergillus is an opportunistic fungus that usually colonizes preexisting lung cavities, especially tuberculous ones. Colonization of a pulmonary sequestration by this germ is exceptional, with just 14 cases reported in the world literature, most of them in Asia. A case is presented of a 48-year-old woman with pleuritic thoracic pain. Simple chest radiology revealed a lower right pulmonary tumor with clear margins and a calcium-type density. CT showed it to correspond to a 6 x 5-cm hypodense mass, which was enhanced at the periphery with intravenous contrast. Aspiration puncture yielded a greenish-yellow pus and the microscopic study strongly suggested Aspergillus, confirmed by culture as Aspergillus fumigatus. Surgery revealed an infected pulmonary sequestration at the lower right lobe, and a lobectomy was performed.