We report the results of our experience using video-assisted thoracoscopic surgery (VATS) to treat primary spontaneous pneumothorax (PSP) from January 1992 until December 1994 in a multicentered co-operative study.A total of 132 patients (110 males and 22 females, aged 13-38 yrs, mean age 26 yrs) were treated by VATS to deal with the PSP that they presented with. A standard VATS technique was used. Apical bullae were always removed, and mechanical pleural abrasion was performed, leaving a pleural drainage tube.In two cases (1.5%), a switch to thoracotomy was necessary. In eight cases (6%), air leakage persisted for 5 days after surgery, which resolved with pleural drainage. There were eight postoperative relapses (6%), which were treated with pleural drainage (n=4), VATS (n=3) or axillar thoracotomy (n=1). The average postoperative stay was 5.6 days (range 2-15 days).We conclude that video-assisted thoracoscopic surgery is a viable alternative for the treatment of primary spontaneous pneumothorax. There is, however, a high relapse rate, and in a number of cases air leakage persists in the postoperative period. Eur Respir J 1997; 10: 409-411 Primary spontaneous pneumothorax (PSP) is a benign process, but persistent air leaks or recurrence make surgical intervention necessary in 30-40% of cases. PSP has come to be treated in the classic form, through axillar thoracotomy; the results published have been good, with a minimum rate of relapse and morbidity [1][2][3][4]. Recent developments in video-assisted thoracoscopic surgery (VATS) allowed a change in surgical technique, reducing surgical intervention. In order to evaluate VATS technique in PSP we initiated a multicentered study covering a period of 3 yrs. Materials and methodsBetween January 1992 and December 1994, a co-operative multicentered study was carried out by the Thoracic Surgery departments of three teaching hospitals. A total of 132 patients affected with PSP were treated by VATS. The indications for surgery for PSP were as follows: 1) persistent air leakage of more than 7 days after pleural drainage at the first episode of PSP (n=24); and 2) ipsilateral relapse in a case of PSP previously treated by pleural drainage (n=108). Cases of spontaneous pneumothorax, in which the patient had no primary pulmonary disease, were considered to have PSP.Patients treated through axillar thoracotomy during this same period of time were excluded from the study, as were patients with secondary pneumothorax, those more than 40 yrs of age (although not suspected of having basic pulmonary disease), and those of traumatic origin.The technique used was the same in all cases. It was carried out using general anaesthesia with a doublelumen endobronchial tube. Three incisions were made in order to introduce the optical equipment, the thoracic endoscopy instruments, and the endosutures. A removal of (generally apical) bullae or dystrophic complexes responsible for the episodes of pneumothorax was always performed. In cases of air leakage, air leak tests were performe...

INTRODUCCIÓNLa amebiasis puede ser considerada como una de las enfermedades más agresivas del intestino en su forma invasiva. La principal forma de presentación extraintestinal es el absceso hepático, que puede desarrollar serias complicaciones si no es rápidamente diagnosticado y correctamente manejado (1,2).La infección por Entamoeba Histolytica se da más frecuentemente en países subdesarrollados como la India, regiones tropicales de África, México y algunas zonas de Brasil, notándose un incremento en países desarrollados como EE.UU. o europeos, donde la modernización del transporte ha incrementado la llegada de extranjeros infec- RESUMENAntecedentes: los abscesos amebianos hepáticos se presentan frecuentemente en zonas endémicas, teniendo mal pronóstico si no son diagnosticados y tratados adecuadamente.Objetivo: evaluar nuestros resultados, ampliar la clasificación ultrasonográfica utilizada y proponer un algoritmo terapéutico.Diseño: retrospectivo observacional. Método: revisión de los expedientes clínicos de los pacientes y valoración de los siguientes datos: sexo, edad, signo-sintomatología, métodos complementarios de imágenes y laboratorio, tamaño, localización, estancia hospitalaria y tratamiento.Resultados: fueron tratados 16 abscesos, 9 fueron hombres, la media etaria fue de 30,56 años, todos fueron únicos, 14 se localizaron en el lóbulo derecho, la media en medida fue de 63,25 milímetros, 10 fueron del tipo coleccionado en la clasificación de N'Gbesso. Siete pacientes tuvieron buena respuesta con el tratamiento médico, en 6 se realizó drenaje percutáneo y en 3 cirugía. La morbilidad fue del 12,5% y la mortalidad del 0%. La estancia hospitalaria global tuvo una media de 7,68 días.Conclusión: nuestros resultados son similares a otras series, el agregado a la clasificación de N'Gbesso de abscesos intermedios y complicados o con signos de alarma mejora la orientación terapéutica, creemos que el drenaje precoz en abscesos coleccionados de 5 o más cm mejora la sintomatología y disminuye la estancia hospitalaria.Palabras clave: Absceso amebiano hepático. Drenaje precoz. ABSTRACTBackground: amebic liver abscess is frequently seen in endemic regions, and has a poor prognosis when diagnosis and treatment are inappropriate.Aim: to evaluate and compare our own results; to propose a new classification and therapeutic algorithm.Design: an observational and retrospective study. Method: medical records were reviewed for sex, age, signs and symptoms, images, laboratory tests, size, location, treatment, hospital stay, and morbidity-mortality.Results: sixteen patients with amebic liver abscess had been treated -9 were males, mean age was 30.56 years, all abscesses were solitary, 14 were in the right hepatic lobe, average size was 63.25, and 10 were of the collected type according to N'Gbesso's classification. Seven patients had a good response to medical treatment, 6 needed percutaneous drainage, and 3 required surgery. Morbidity was 12.5% and mortality 0%. Average hospital stay was 7.68 days.Conclusion: our results ar...