This study was undertaken to prospectively evaluate breast sensibility before and after reduction mammaplasty with a new, objective, and quantitative neurophysiologic method based on the anatomic knowledge of breast innervation and the congruent areas of dermatomal maps. An innovative application of dermatomal somatosensory evoked potentials was used to study the breast regions of 42 healthy women, bilaterally. The areas stimulated in each breast were the superior quadrant, the nipple-areola complex and the medial and lateral quadrants, and the inferior quadrant; these areas correspond to T3, T4, and T5 dermatomes, respectively, following the accepted concepts of segmentary innervation of the skin. The two groups of 21 patients each were formed according to breast size: group I comprised small-breasted, unoperated controls (brassiere cup size A or B); group II comprised macromastia patients (brassiere cup size C or greater) who presented to a general plastic surgery department for breast reduction surgery. First the authors established the normal range of latency and amplitude in the dermatomal somatosensory evoked potentials for the five areas stimulated in patients with small breasts and compared these parameters with those obtained from patients with macromastia. Then, after the macromastia patients underwent reduction mammaplasty using the McKissock technique, the authors compared the postoperative sensory values with their own preoperative values and with those from the small-breasted group. Using dermatomal somatosensory evoked potentials, they found that small breasts were statistically more sensitive than large breasts, which concurs with studies in the literature that use other methods to evaluate breast sensibility. They also found that after breast reduction, the macromastia patients presented statistically significant improvement in breast sensibility in relation to their own preoperative latency and amplitude values, with no statistical difference in amplitude with respect to the small-breasted group; this finding suggests that after breast reduction, sensibility similar to that of the small-breasted group can be considered a possibility. Furthermore, in comparisons of each of the five areas stimulated, there was no significant difference in values within the small-breasted group or within the macromastia group before or after surgery; this supports a possible overlap between adjacent dermatomes. This innovative application of dermatomal somatosensory evoked potentials is an objective, quantitative, and noninvasive method that has allowed the authors to evaluate breast sensibility and to compare postsurgical sensory outcomes.

Resumen Objetivo: Estimar la asociación entre tabaquismo pasivo y activo y cáncer pulmonar (CP) en la Ciudad de México (CM), así como los riesgos atribuibles asociados. Material y métodos: Se analiza un estudio multicéntrico de casoscontroles con base poblacional, realizado en la CM. Resultados: Las RM para CP en alguna vez fumadores fueron de 6.2 (IC 95% 3.9, 10.2) en hombres y 2.8 (IC 95% 1.7, 4.4) en mujeres. La exposición pasiva al tabaco mostró una RM en ambos sexos de 1.8 (IC 95% 1.3, 2.6), similar en ambos sexos. Los riesgos atribuibles asociados al tabaquismo activo para ambos sexos, hombres y mujeres fueron de 55, 76 y 27%, respectivamente. El riesgo atribuible para tabaquismo fue de 17% en mujeres, 3.9% en hombres y 12% en ambos sexos. Conclusiones: En la CM el tabaquismo explica una fracción menor de casos de CP que el estimado en países desarrollados. Esto se debe a que en México la intensidad del tabaquismo es menor.Palabras clave: cáncer pulmonar, tabaquismo, razón de momios, riesgo atribuible, métodos epidemiológicos, casos-control; México AbstractObjective. To estimate the association between passive and active smoking exposures and lung cancer in Mexico City and the corresponding attributable risks. Material and Methods. Data was analyzed from a multicenter population-based case-control study conducted in Mexico City. Results. ORs for lung cancer in ever smokers were 6.2 (95% CI 3.9-10.2) for males and 2.8 (95% CI 1.7-4.4) for females. Passive smoking at home showed an overall OR of 1.8 (95% CI 1.3-2.6), similar in both genders. Attributable risk for active smoking for both genders combined, and for males and females separately, was estimated at 55, 76 and 27%, respectively. Attributable risk for passive smoking at home was 17% for females, 3.9% for males and 12% for the entire population. Conclusions. In Mexico City smoking is attributable to a smaller proportion of lung cancer cases than in developed countries. This is explained by a lower intensity of smoking in the Mexican population.

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Surgeries are practiced in different areas, and specifically in the thorax described in this chapter, the medical doctors must know in detail the biological structures in which they perform such surgical procedures. Therefore, in this chapter, we refer to the descriptive and topographical anatomy written by French doctors L. Testut and A. Latarjet. In earlier times, for several reasons, the medical surgeon operated all body organs and was involved in resolving the pathology of different areas. Currently and in the future, medical knowledge in thoracic surgery will cover subspecialties specifically divided, for example: assisted video surgery, interventional bronchoscopy, and mediastinoscopies to take mediastinal biopsies using robotic surgery of pulmonary exeresis to shorten the hospitalization period and even the days spent in the intensive care unit.

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