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Resumen Introducción: en la actualidad no existe un consenso respecto al manejo de los nódulos pulmonares subsólidos (NPSS). Objetivo: describir los resultados del manejo quirúrgico de los NPSS, basados en un algoritmo local. Material y Métodos: estudio descriptivo de corte transversal. Se revisaron las fichas clínicas electrónicas de los pacientes operados por NPSS, sugerentes de ser malignos, a juicio de un equipo multidisciplinario, entre enero de 2014 y enero de 2018, en el Departamento de Cirugía de Adultos de Clínica Las Condes. Resultados: se estudió un total de 35 pacientes. La edad promedio fue de 65,8 años. El tamaño promedio de los nódulos fue de 15 mm. Todos los pacientes fueron abordados por cirugía videotoracoscópica asistida. El 88,6% de las biopsias demostró la presencia de una neoplasia maligna. Conclusiones: la adopción de un algoritmo local, instituido por un equipo multidisciplinario, es una alternativa para el manejo adecuado de los portadores de NPSS.

The number of patients waiting for a lung transplant worldwide greatly exceeds the number of available donors. Ex vivo lung perfusion is a useful tool that allows marginal donor lungs to be evaluated and reconditioned for a successful lung transplantation.To describe the first Chilean and Latin American experience in ex vivo lung perfusion for marginal donor lungs before transplantation.Descriptive analysis of all ex vivo lung perfusion conducted for marginal donor lungs at a private clinic, from April 2019 to October 2020. High risk donor lungs and rejected lungs from other transplantation centers were included. The "Toronto Protocol" was used for ex vivo lung perfusion. Donor lung characteristics and recipient outcomes were studied.During the study period, five ex vivo lung perfusions were performed. All lungs were reconditioned and transplanted. No complications were associated. There were no primary graft dysfunctions and only one chronic allograft dysfunction. There was no mortality during the first year. The median arterial oxygen partial pressure/fractional inspired oxygen ratio increased from 266 mm Hg in the donor lung to 419 after 3 hours of ex vivo lung perfusion (p = 0.043).ex vivo lung perfusion is a safe and useful tool that allows marginal donor lungs to be reconditioned and successfully transplanted.

Background Pulmonary nodules are common, and surgery is the only alternative that allows a diagnostic and therapeutic management in a single procedure. Aim To report the epidemiological, radiological, surgical and pathological features of excised pulmonary nodules. Material and methods Review of medical records of patients in whom a pulmonary nodule was excised between 2014 and 2018. Those with incomplete data or without a pathological study were excluded from analysis. Results We retrieved 108 records and 8 had to be excluded, therefore 100 patients aged 34 to 82 years (57% females) were analyzed. Sixty percent had a history of smoking. Mean nodule size was 16 mm and the solid type was the most common (65%). Forty five percent of nodules had irregular margins and 55% were in the superior lobes. All patients operated by video-assisted thoracoscopic surgery and 40% underwent a lobectomy. Malignant lesions were observed in 87% of biopsies and a pulmonary adenocarcinoma was found in pathology in 40%. Conclusions A multidisciplinary approach of pulmonary nodules, using adapted international guidelines, accomplishes an appropriate management, decreasing unnecessary surgical interventions.

Pulmonary nodules are common, and surgery is the only alternative that allows a diagnostic and therapeutic management in a single procedure.To report the epidemiological, radiological, surgical and pathological features of excised pulmonary nodules.Review of medical records of patients in whom a pulmonary nodule was excised between 2014 and 2018. Those with incomplete data or without a pathological study were excluded from analysis.We retrieved 108 records and 8 had to be excluded, therefore 100 patients aged 34 to 82 years (57% females) were analyzed. Sixty percent had a history of smoking. Mean nodule size was 16 mm and the solid type was the most common (65%). Forty five percent of nodules had irregular margins and 55% were in the superior lobes. All patients operated by video-assisted thoracoscopic surgery and 40% underwent a lobectomy. Malignant lesions were observed in 87% of biopsies and a pulmonary adenocarcinoma was found in pathology in 40%.A multidisciplinary approach of pulmonary nodules, using adapted international guidelines, accomplishes an appropriate management, decreasing unnecessary surgical interventions.

Introducción: En Chile se consensuaron una serie de criterios de urgencia para trasplante pulmonar con el fin de disminuir la mortalidad de candidatos en lista de espera. Objetivo: Evaluar la sobrevida a corto plazo de pacientes trasplantados en condición de urgencia. Metodología: Análisis retrospectivo de fichas clínicas de pacientes trasplantados desde enero del 2012 a julio del 2015. Se consignó datos demográficos, enfermedad de base, complicaciones precoces, tardías y sobrevida. Resultados: De 59 pacientes trasplantados en este período 18 han sido en urgencia. Enfermedad de base: fibrosis pulmonar (n = 13), fibrosis quística (n = 3), bronquiolitis obliterante (n = 1), hipertensión pulmonar (n = 1). La dependencia de ventilación mecánica no invasiva fue el principal motivo de urgencia (89%). Un 76% requirió de soporte extracorpóreo intraoperatorio. La sobrevida a 30 días y a 12 meses fue de 94 y 87% respectivamente. Conclusión: El trasplante pulmonar en situación de urgencia es un procedimiento con buenos resultados en sobrevida a corto plazo.

Sólo 45 centros en el mundo desarrollan trasplantes pulmonares en niños. Objetivo: Evaluar resultados de pacientes ≤ 20 años trasplantados de pulmón. Material y Método: Análisis retrospectivo de registros clínicos de estos pacientes en Clínica Las Condes. Resultados: Diez pacientes ≤ 20 años han sido trasplantados de pulmón. La edad promedio al momento del trasplante fue de 15,8 años. La principal indicación fue fibrosis quística en 8 pacientes. El VEF1 promedio basal fue de 31,3% de su valor de referencia, con mejoría progresiva post-trasplante siendo al año de 76,7% y a los 2 años de 75%, Complicaciones precoces fueron infecciones y rechazo. Complicaciones tardías fueron principalmente infecciones de origen viral. Seis pacientes lograron continuar sus estudios. La sobrevida a 30 días, al 1er y 5º año fue de 80%,70% y 58% respectivamente. Conclusión: El trasplante pulmonar es una alternativa válida en niños y adolescentes con enfermedades pulmonares avanzadas con resultados aceptables a largo plazo.

La Fibrosis pulmonar es una enfermedad progresiva y el trasplante constituye una terapia efectiva para un grupo de pacientes. Objetivo: Evaluar los resultados del trasplante pulmonar por fibrosis a 5 años. Metodología: Revisión retrospectiva de registros de trasplante pulmonar de la Clínica Las Condes e Instituto Nacional del Tórax. Se analizaron datos demográficos, tipo de trasplante, función pulmonar basal y post-trasplante, complicaciones precoces y tardías y sobrevida a largo plazo. Resultados: Entre 1999 y 2015 ambos centros trasplantaron 87 pacientes por fibrosis pulmonar. Los pacientes tenían una edad promedio de 56 años, 56% eran del género masculino y se usó técnica monopulmonar en 89% de ellos. 16% de los pacientes se encontraba en urgencia. Los resultados espirométricos y la distancia caminada en 6 minutos (T6 min) basales y a 1- 3 - 5 años fueron: CVF 49- 73- 83 y 78% del valor teórico y T6 min fue 280, 485, 531 y 468 metros respectivamente. Complicaciones predominantes < 1 año fueron: rechazo agudo 30% e infecciones 42%. Complicaciones > 1 año fueron: disfunción crónica del injerto (DCI) 57% y neoplasias 15%. Las causas de mortalidad > 1 año fueron DCI 45% y neoplasias 11%. La sobrevida estimada a uno, 3 y 5 años fue 84, 71 y 58% respectivamente. Conclusiones: El trasplante en pacientes con fibrosis pulmonar, permite mejorar la calidad de vida y sobrevida de estos pacientes. La técnica monopulmonar es eficiente a largo plazo. En las complicaciones precoces predominaron el rechazo agudo e infecciones y a largo plazo la DCI.

Introducción: En las últimas dos décadas los avances en cirugía mínimamente invasiva han revolucionado la práctica quirúrgica en todas las subespecialidades. En resecciones pulmonares la lobectomía por videotoracoscopía (VATS), en comparación con resecciones por toracotomía, ha demostrado, además del menor número de complicaciones perioperatorias, una menor respuesta inflamatoria y equivalencia en resultados oncológicos. Pacientes y Métodos: Se presenta una serie retrospectiva de 30 pacientes en quienes se realizó una lobectomía por VATS. Se analizan los resultados con respecto a complicaciones quirúrgicas y postquirúrgicas y considerando variables de diagnóstico, linfadenec-tomía, sangrado quirúrgico, conversión a toracotomía, tiempo operatorio, días de estadía y días con pleurostomía. Resultados: Las indicaciones quirúrgicas de nuestra serie fueron en un 90% (n = 27) por patología neoplásica, el 10% restante (n = 3) correspondió a patología benigna (bronquiectasias). La etapificación TNM dentro del subgrupo de cáncer pulmonar se distribuyó homogéneamente entre las etapas I y II. La linfadenectomía obtuvo un promedio de 13 ganglios con un rango entre 9 y 18. El tiempo quirúrgico promedio fue de 124 minutos. De las complicaciones, un 50% de estas (n = 3) se debieron a sangrado de más de 1.000 mL. La tasa de conversión en nuestra serie es de 16,6% (5 casos). El promedio de días con drenaje fue de 4,09 días con rango entre 2 y 9 días. No hubo mortalidad a 60 días. Conclusión: En la serie presentada se evidencia que la lobectomía por VATS es equivalente a la toracotomía con respecto al número de complicaciones. Creemos como equipo que presenta beneficios en el tiempo de recuperación del paciente.

Los tumores del mediastino pueden tener múltiples formas de presentación y diversos orígenes anato-mopatológicos. A veces alcanzan gran tamaño y pueden comprometer por compresión o infiltración el sistema de la vena cava superior. Presentamos el caso de un hombre de 48 años que consultó por disnea, cefalea y palpitaciones en decúbito de dos meses de evolución. En la radiografía y en la tomografía computada de tórax se demostró un tumor de mediastino anterior, el estudio anatomopatológico mediante biopsia trucut concluyó leiomiosarcoma. Se realizó tratamiento quirúrgico, se resecó la masa tumoral que comprometía el sistema de la vena cava superior, se ligó y resecó el tronco venoso braquiocefálico izquierdo o innominado y se reconstruyó parte de la vena cava superior con parche de pericardio autólogo. El nervio frénico derecho se encontraba rodeado por la masa tumoral y se resecó junto con el tumor. El paciente evolucionó satisfactoriamente y fue dado de alta al décimo primer día post operado. El estudio de anatomía patológica de la pieza operatoria confirmó un leiomiosarcoma G2 de 3.100 gramos. Se completó tratamiento con radioterapia post operatoria. A 15 meses post operado el paciente se encuentra en buenas condiciones generales, sin evidencias de recidiva y sin síndrome de vena cava superior.

Background: PET/CT (Positron Emission Tomography/Computed Tomography) is widely used in nodal and metastatic staging of lung cancer patients. Aim: To analyze PET/CT detection of metastatic disease in patients with lung cancer. Material and Methods: We reviewed retrospectively F18Fluorodeoxyglucose PET/CT scans performed between December 2008 and December 2013. We selected 143 patients aged 30 to 92 years (63% males) with confirmed lung cancer referred for staging, with no previous treatment. We reviewed whole body PET/CT and brain magnetic resonance images. SUVmax (Standardized Uptake Value maximum) of primary pulmonary lesion, hilar/mediastinal nodes, and distant metastases were calculated. Results: Histological types encountered were adenocarcinoma in 55%, squamous-cell in 15%, small-cell in 8%, large-cell in 6% and adeno-squamous in 2%. In 22 cases (15%) histology was not available. Nodal involvement was observed in 60% of patients (44% hilar and 48% mediastinal). Skip metastases (mediastinal involvement without hilum involvement) were encountered in 17% of cases, and were significantly more common among high uptake lung tumors (p < 0.01). Best SUVmax cut-off for node involvement was 4.4 for hilum and 4.0 for mediastinum (sensibility: 86.4%, specificity: 99.8%). Sixty six patients (46.2%) showed distant metastases on PET/CT. The most common metastases were osseous in 22%, adrenal in 16%, hepatic in14%, pulmonary in 14% and cerebral in 12%. PET/CT detected a second unexpected synchronic cancer in eight patients (6%). Conclusions: PET/CT is accurate for nodal staging using an uptake index as SUVmax. Distant metastases are common, especially in bone, adrenal glands and liver.

PET/CT (Positron Emission Tomography/Computed Tomography) is widely used in nodal and metastatic staging of lung cancer patients.To analyze PET/CT detection of metastatic disease in patients with lung cancer.We reviewed retrospectively F18Fluorodeoxyglucose PET/CT scans performed between December 2008 and December 2013. We selected 143 patients aged 30 to 92 years (63% males) with confirmed lung cancer referred for staging, with no previous treatment. We reviewed whole body PET/CT and brain magnetic resonance images. SUVmax (Standardized Uptake Value maximum) of primary pulmonary lesion, hilar/mediastinal nodes, and distant metastases were calculated.Histological types encountered were adenocarcinoma in 55%, squamous-cell in 15%, small-cell in 8%, large-cell in 6% and adeno-squamous in 2%. In 22 cases (15%) histology was not available. Nodal involvement was observed in 60% of patients (44% hilar and 48% mediastinal). Skip metastases (mediastinal involvement without hilum involvement) were encountered in 17% of cases, and were significantly more common among high uptake lung tumors (p0.01). Best SUVmax cut-off for node involvement was 4.4 for hilum and 4.0 for mediastinum (sensibility: 86.4%, specificity: 99.8%). Sixty six patients (46.2%) showed distant metastases on PET/CT. The most common metastases were osseous in 22%, adrenal in 16%, hepatic in14%, pulmonary in 14% and cerebral in 12%. PET/CT detected a second unexpected synchronic cancer in eight patients (6%).PET/CT is accurate for nodal staging using an uptake index as SUVmax. Distant metastases are common, especially in bone, adrenal glands and liver.

Objectives: To describe and evaluate factors associated with morbidity and mortality in surgically treated parapneumonic empyemas (PNE). Method: Retrospective review between January 2000 and August 2006. We described clinical features and we performed univariate and multivariate analysis to find the factors associated with morbidity and mortality. SPSS 15.0 program was used in the statistical analysis. Results: 242 of343 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 fluid 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 difficult to identify. Decortication is the most common surgical treatment. Morbidity and mortality are present. Variables associated with morbidity and mortality were identified in this clinical series.

Pleural empyema. Retrospective review of 343 patients Background: 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: Retros-pective 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 trau-ma 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 surge-ries (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.Key words: Empyema, thoracotomy, pneumonia.ResumenObjetivos: Describir caracteristicas, resultados inmediatos y evaluar factores asociados a morbi-mortalidad de Empiema Pleural (EP) con tratamiento quirurgico. Metodo: Revision retrospectiva. Periodo: enero 2000 - agosto 2006. Se describen caracteristicas, resultados inmediatos y factores asociados a morbi-mortalidad. Se utilizo programa SPSS 15.0. Se considero significativo p < 0,05. Resultados: 343 pacientes

esta tecnica fue disenada para pacientes pediatricos pero su indicacion se ha am-pliado a pacientes adultos. El tratamiento tradicional de esta deformidad de la pared toracica implicaba plastias con extensas resecciones condro-costales. Esta nueva y revolucionaria tecnica, consiste en la instalacion de una barra metalica retroesternal por un periodo de 2 a 3 anos con lo que se corrige el defecto

A minimally invasive technique or Nuss procedure was devised for children with pectus excavatum (funnel chest), but it is also used in adult patients.To report the experience with the Nuss procedure in adults' patients with pectus excavatum.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, was recorded.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. AU 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 (p0.05).Nuss operation is feasible and safe in adults with pectus excavatum.

Pulmonary arteriovenous fistula in hereditary hemorrhagic telangiectasia. Report of one case Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) is an autosomal dominant vas- cular disease that can be associated with pulmonary arteriovenous fistulas. We report a 16 years old female with an Osler-Weber-Rendu syndrome and a history of frequent episodes of epistaxis since the age of 10 years. A Chest CAT scan performed on that occasion showed an arteriovenous fistula. The patient presented with progressive dyspnea, low arterial oxygen saturation and clubbing of fingers. An echocardiogram and lung perfusion scintigram confirmed the presence a right to left shunt. The patient was subjected to a lobectomy with a good postoperative evolution.

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

Introducción: La Apendicitis Aguda (AA) es la emergencia quirúrgica más frecuente. La proteína C reactiva (PCR) es una proteína de fase aguda que sería de utilidad en el diagnóstico de AA. El objetivo de este trabajo es determinar el rendimiento de la PCR y el recuento de leucocitos (RL) en el diagnóstico de AA. Material y Método: Estudio prospectivo entre Marzo 2002 y Julio 2003. A todo paciente ingresado con sospecha de AA se le midió PCR y RL. El diagnóstico definitivo se hizo con el estudio histopatológico. Los pacientes no operados fueron seguidos hasta un mes después del alta. Se determinó los valores promedio de cada variable y se elaboró una curva ROC para RL y PCR. Resultados: Fueron incluidos 79 pacientes (43F/36M), con un edad promedio de 29+12,5 años. El promedio de duración de los síntomas hasta el ingreso fue de 30+24 hrs. Cincuenta y dos pacientes (65%) fueron sometidos a cirugía y se confirmó AA en 46 de ellos (88%). El cálculo de curvas ROC para PCR muestra el punto de corte (mejor valor de sensibilidad y especificidad) en 2,5mg/dL, con un área bajo la curva de 0,86, mientras que el cálculo para el RL muestra un punto de corte de 12700/mm³ y un área bajo la curva de 0,73. El RL muestra mejor sensibilidad, especificidad, VPP, VPN, LR(+) y LR() comparado con la PCR. La combinación de PCR >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 Background: Appendicitis is the most common surgical emergency of the abdomen. C-reactive protein (CRP) is one of the acute phase proteins, it may be useful in the diagnosis of appendicitis. The aim of this study was to determine the accuracy of CRP and leukocyte count measurement in the diagnosis of appendicitis. Patients and Methods: The study was performed prospectively from March 2002 to July 2003. CRP and leukocyte count was measured at admition when appendicitis was suspected. Diagnosis was confirmed with biopsy and patients were followed one month after admition. Results: Seventy nine patients were included in this study, 43 (54 percent) were female. Mean age was 29 ± 12,5 years old. The mean time of symptoms before admition was 30 ± 24 hours. Fifty two patients (65 percent) underwent surgery; in 46 of them (88 percent) appendicitis was confirmed in biopsy. According to ROC curves the higher sensitivity and specificity for CRP and leukocyte count was 2,5 mg/dL y 12700/mm³ respectively. The leukocyte count had a higher sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratio (LR) compared to CRP in diagnosis of appendicitis. CRP and leukocyte count combination had a higher specificity, PPV and LR (+). Discussion: Leukocyte count had more accuracy compared to CRP in diagnosis of appendicitis