Background:Hamman (Rev Méd Chile 2009; 137: 1045-50).
Thymic epithelial tumors. Retrospective review of 54 patientsBackground: Thymic epithelial tumors are uncommon and can be associated with myasthenia gravis. Aim: To describe variables associated with survival and treatment of thymic epithelial tumors. Material and Methods: Retrospective review of surgical databases of a respiratory diseases hospital, identifying patients operated for a thymic epithelial tumor between 2000 and 2010. Follow up lasted from 12 to 156 months and information was obtained from medical records and death certificates of the Chilean national identification service. Results: Data from 54 patients aged 52.5 ± 16.4 years (33 women) was retrieved. Forty two patients were symptomatic and 47 were subjected to resective surgery. The pathological diagnosis was thymoma in 46 cases and thymic carcinoma in eight. Fourteen patients had postoperative complications and one died. Mean survival time was 101.8 ± 10.2 months. One, three and five years survival was 90.7 ± 3.9, 81.4 ± 5.7 and 71.8 ± 8.2%, respectively. Preoperative performance status of patients, histological type of the tumor and associated myasthenia gravis were predictors of survival. Conclusions: More commonly, thymic epithelial tumors appear in women, their histological type corresponds to thymomas and their resection is feasible
Pleural empyema. Retrospective review of 343 patientsBackground: Pleural empyema still has a dismal prognosis. Aim: To describe features and prognostic factors of patients with pleural empyema subjected to surgical procedures. Material and Methods: Retrospective review of 343 patients with pleural empyema (mean age 52 years, 71% males), that were subjected to any type of surgical procedure. Criteria for diagnosis of empyema were a positive culture, a fluid pH of less than 7.2 or a compatible macroscopic appearance of the fluid. Results: Empyema was secondary to pneumonia in 243 patients (71%), secondary to surgical procedures in 41 patients (12%), secondary to trauma in 19 patients (5.5%), secondary to a lung abscess in 10 patients (3%), tuberculous in 10 patients (3%), neoplastic in two cases (0.6%), secondary to pneumothorax in 2 cases (0.6%) and of unknown origin in 13 patients (4%). A microorganism was isolated from pleural fluid in 89 patients (26%). The surgical procedures performed were 251 decortications by thoracotomy (73%), 70 pleurotomies (20%), 11 video assisted surgeries (3%), seven decortications with lung resections and four fenestrations. Complications were recorded in 104 patients (30%), 29 patients were re-operated (8.5%) and 31 died (10%), all due to sepsis. Conclusions: The main cause of pleural empyema is pneumonia. In most patients, microorganisms are not isolated from pleural fluid, thoracotomy with decortication is the most frequent surgical procedure. There is a high rate of complications and mortality.
PCI-S and CABG groups, respectively (Odds ratio (OR) 2.27; 95% confi dence intervals (CI) 1. 66-3.09). There were no differences in death or myocardial infarction. Strokes were less common in the PCI-S group (OR 0.25, and coronary re-intervention was required with higher frequency in the PCI-S group (OR 5.32, (Rev Med Chile 2012; 140: 640-648).
Parapneumonic empyema: characterization and factors associated with morbidity and mortality in 242 surgical casesObjectives: To describe and evaluate factors associated with morbidity and mortality in surgically treated parapneumonic empyemas (PNE). . We described clinical features and we performed univariate and multivariate analysis to fi nd the factors associated with morbidity and mortality. SPSS 15.0 program was used in the statistical analysis. Results: 242 of 343 surgically treated empyemas (70.6%) were paraneumonic. Of these 165 (68.2%) were men, average age 52.1 years, 229 (94.6%) were community-acquired pneumonia (CAP) and 13 (5.4%) nosocomial. Germs were isolated in pleural fl uid in 57 (23.6%). Surgical procedures were: 183 (75.6%) decortications, 49 (20.2%) pleurotomies, 7 (2.9%) video-assisted surgery and 3 (1.2%) decortications with pulmonary resection. Complications occurred in 65 cases (26.9%) and 16 patients died (6.6%). We found variables associated with morbidity and mortality. Conclusions: PNE is the most common cause of empyema, mostly associated with CAP and germs are diffi cult to identify. Decortication is the most common surgical treatment. Morbidity and mortality are present. Variables associated with morbidity and mortality were identifi ed in this clinical series. ResumenObjetivos: Describir las características y evaluar los factores asociados a morbi-mortalidad en el empiema paraneumónico (EPN) tratado quirúrgicamente. Método: Revisión retrospectiva entre Enero 2000 y Agosto 2006. Se describen características y factores asociados a morbi-mortalidad, se realizó análisis univariado y multivariado utilizando programa SPSS 15.0. Resultados: 242 pacientes tenían EPN (70,6% de los empiemas tratados), 165 (68,2%) fueron hombres, edad promedio 52,1 años, 229 (94,6%) fueron neumonías adquiridas en la comunidad (NAC) y 13 (5,4%) intrahospitalarias. Se aisló gérmenes en líquido pleural en 57 (23,6%). Se realizaron 183 (75,6%) decorticaciones, 49 (20,2%) pleurotomías, 7 (2,9%), cirugías video-asistidas y 3 (1,2%) decorticaciones con resección pulmonar. Presentaron complicaciones 65 (26,9%). Fallecieron 16 pacientes (6,6%). Se identifi caron variables asociadas a morbi-mortalidad. Conclusiones: El EPN es la causa más frecuente de empiema, la mayoría está asociado a NAC y en pocos se identifi can gérmenes. La decorticación es el procedimiento más frecuente. Se identifi caron las variables asociadas a morbi-mortalidad en esta serie clínica.Palabras clave: Empiema pleural, patología pleural, neumonía, cirugía torácica, morbilidad, mortalidad. No existen confl ictos de interés ni apoyo fi nanciero extrainstitucional.
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