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The traditional approach to infrastructural safety follows the consideration of mitigation tools, such as the identification and management of black spots or road sections with high accident concentration, or preventing tools, as road safety audits and inspections. A complement to these tools is presented in this paper, from a new perspective: the consideration of road sections where, under similar conditions and similar risk exposure, there are no accidents (white road sections). A model has been calibrated to the Spanish toll motorways network, identifying the specific geometric parameters and traffic characteristics which have the highest influence in the occurrence of white sections with sufficient length, without accidents during a significant period of time: heavy vehicles traffic volume, with of the road section and speed. El planteamiento tradicional de análisis de la accidentalidad en carretera pasa por la consideración de herramientas paliativas, como son la identificación y gestión de los puntos negros o tramos de concentración de accidentes, o preventivas, como las auditorías o inspecciones de seguridad vial. En este artículo se presenta un complemento a estas herramientas, desde una perspectiva novedosa: la consideración de los tramos donde, bajo unas condiciones similares a las de otros tramos y una similar exposición al riesgo, no se producen accidentes (tramos blancos). Se resume el modelo que se ha calibrado para las autopistas de peaje españolas, identificando los parámetros específicos de la geometría de la vía y del tráfico que más influencia tienen en el hecho de que en algunos tramos de suficiente longitud, no se produzcan accidentes durante un periodo significativo de tiempo: el tráfico de pesados, al ancho de calzada y la velocidad de circulación.

We report the case or a 40-year-old man with a large right parasternal tumor. Computerized tomography (CT) and magnetic resonance (MR) imaging showed a soft tissue mass infiltrating contiguous structures with no sign of adenopathy and with disease limited the chest wall. The histological type was granular cell tumor (GCT) with discrete cell pleomorphism and nuclei that varied in form and size, with prominent nucleoli. Eighteen months after surgery, the patient was asymptomatic and disease free. GCT is a rare entity that is uncommonly found on the chest wall. A diagnosis of malignancy is established when metastasis is found to be of the same histological type as that of the primitive tumor. Neither cell pleomorphism or nuclei with nucleoli allows for a diagnosis of malignancy; only a size greater than 5 cm and locally invasive behavior should lead to an assumption that these tumors are of unspecified malignancy. We believe the treatment of choice for these lesions is radical removal

The outcome of video-assisted thoracoscopic treatment of spontaneous pneumothorax was analyzed. Eighty-three procedures were performed in 79 patients (58 men, 21 women: mean age 28.3 years, range 16 to 76 years). The reasons for intervention were recurring pneumothorax in 53 patients, contralateral pneumothorax in 10 (one of whom was treated on both sides), bilateral involvement in 3, and persistent air leakage in 13. Seven patients (8.4%) also required open thoracotomy. In 72 (88%) of the remaining 76 procedures, only video thoracoscopy was used. Three patients (3.6%) underwent video-assisted thoracotomy. Mean postoperative hospital stay was 5.1 days (2 to 24 days). No related deaths occurred but surgical complications were reported for 3 (3.9%). Significant postoperative complications developed in 9 cases (11.8%). One patient with prolonged air leakage underwent a second procedure, video-assisted thoracotomy, 12 days after the first intervention. Seventy-one of the 72 patients received follow-up examinations, with a mean follow-up period of 28.1 months (range 54 days to 54 months). Three recurrences (3.9%) were recorded but there were no cases of chronic pain requiring analgesia. We conclude that video thoracoscopy is an effective approach, with the advantage of being minimally invasive. We therefore believe it should be the procedure of choice, once improved morbidity and recurrence rates are observed, as these factors are influenced by the learning curve.

A case with recurrent hypoglycemias following a thoracic tumor is presented. Neurologic symptoms due to hypoglycemia were dominant. Subcutaneous somatostatin was administrated preoperatively and hypoglycemia was controlled following tumor resection. Histology analysis shows a localized fibrous pleural tumor. Origin has been widely questioned but now it is accepted to be mesenchymal and not mesothelial. Lung disease owing to chronic compression of the tumor made necessary a lobectomy. Postoperative atelectasis required reoperation and a pneumonectomy was performed. To date insulin-like factors secreted by the tumor are supposed to be responsible for hypoglycemics discharges.