2,5 mg/dL y RL >12700/mm³ mejora la especificidad, VPP y LR(+). Conclusión: El RL es más preciso que la PCR para el diagnóstico de AA]]>

Minimally invasive correction of pectus excavatum among adults. Report of eighteen cases Background: A minimally invasive technique or Nuss procedure was devised for children with pectus excavatum (funnel chest), but it is also used in adult patients. Aim: To report the experience with the Nuss procedure in adults patients with pectus excavatum. Material and methods: Prospective study of patients operated between January 2007 and January 2009. Clinical features, symptoms, operative time, postoperative complications, hospital stay and quality of life, using the Nuss questionnaire adapted for adults, were recorded. Results: Eighteen patients aged 18±2 years (14 males) were operated. Seven patients had scoliosis, two had depression, two had asthma and one had a Marfan syndrome. All patients were concerned about aesthetic issues, nine had dyspnea, three had compression of cardiac cavities and three had pulmonary function disturbances. Haller index was 3.8. Mean operative time was 92 minutes. Postoperative complications were a pneumothorax without chest tube management in two patients, a peridural hematoma in one patient and a bar stabilizer infection that required a reoperation in one patient. No patient died and the mean hospital stay was six days. The Nuss questionnaire scores in the pre and postoperative periods were 33 and 48, respectively (p <0.05). Conclusions: Nuss operation is feasible and safe in adults with pectus excavatum (Rev Méd Chile 2009; 137: 1583-90).

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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.

Primary leiomyosarcoma of the mediastinum involving the superior vena cava system. Surgical resection and venous reconstructionMediastinal tumors have multiple presentation forms and various pathological origins. Sometimes they reach a large size and can involve the system of superior vena cava by compression or infi ltration. We present a 48 year old man admited for dyspnea, headache and palpitations in decubitus, for the last two months. The X-ray and chest computed tomography showed an anterior mediastinal tumor and the tru-cut pathological study concluded leiomyosarcoma. He underwent surgical treatment; the tumor compromised the system of the superior vena cava and was resected with ligation and resection the left brachiocephalic trunk. Part of the superior vena cava was reconstructed with autologous pericardium. The right phrenic nerve was surrounded by the tumor mass and was resected in block. The patient recovered satisfactorily and was discharged on the eleventh day post surgery. The histopathologic study of the surgical specimen confi rmed a leiomyosarcoma G2 (3,100 gr). Full adjuvant radiotherapy was done. At 15 months after surgery the patient is in good condition without evidence of recurrence or superior vena cava syndrome.Key words: Leiomyosarcoma, mediastinum, vena cava superior, thoracic surgery, cardiovascular surgical procedures. ResumenLos tumores del mediastino pueden tener múltiples formas de presentación y diversos orígenes anatomopatológicos. A veces alcanzan gran tamaño y pueden comprometer por compresión o infi ltración el sistema de la vena cava superior. Presentamos el caso de un hombre de 48 años que consultó por disnea, cefalea y Rev. Chilena de Cirugía.