F J Moradiellos Díez

Hospital 12 de Octubre, Madrid, Madrid, Spain

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Publications (10)15.46 Total impact

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    ABSTRACT: Postsurgical chylothorax after lung resection has an important associated rate of morbidity and mortality, and a large proportion of cases require re-exploration. The most desirable and least aggressive option is conservative treatment. The use of octreotide seems to be associated with a higher rate of resolution without the need for surgical intervention. We present 4 cases in which this drug showed excellent efficacy and minimal adverse effects in the resolution of postsurgical chylothorax.
    Asian cardiovascular & thoracic annals 10/2005; 13(3):222-4.
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    ABSTRACT: The aim of this study was to describe and to assess the effectiveness of conservative treatment as the chosen treatment for managing iatrogenic tracheobronchial injuries (ITBI). Between January 1993 and December 2003, 33 tracheobronchial injuries were treated in our hospital. Eighteen (54.5%) were ITBI and 15 (45.5%) were traumatic noniatrogenic injuries. Of the ITBI patients, sex distribution was 15 (83%) females and 3 (17%) males with a mean age of 57.7 +/- 20.7 years (range, 17 to 88 years). Fifteen (83.3%) of the injuries were caused by orotracheal intubation and 3 (15.7%) by tracheotomy. The average diagnostic delay was 25.7 +/- 22.9 hours. The mean injury size was 2.83 +/- 1.02 cm (range, 1 to 4 cm). Nine (50%) injuries were located in the cervical trachea, 6 (33.3%) in the thoracic trachea, and 3 (16%) involved both trachea and main bronchi. Conservative treatment was chosen for 17 (94.4%) of the 18 cases. We performed surgical repair in only 1 case owing to progressive subcutaneous emphysema and increasing difficulty with mechanical ventilation. No complications arose from the use of conservative treatment. Four patients (22%) died in our hospital, 3 of these of non-ITBI-related causes. Mortality was not related to four variables: sex, diagnostic delay, location, or size of the ITBI. Fourteen of the 18 patients (77.7%) were discharged uneventfully, and the endoscopic and clinical follow-up examinations were satisfactory in all patients. Conservative treatment for ITBI is effective regardless of production, size, or site of the injuries. Surgical treatment is advisable in specific cases: rapid progression of subcutaneous and mediastinal emphysema, mediastinitis, and difficulty with mechanical ventilation.
    The Annals of thoracic surgery 07/2005; 79(6):1872-8. · 3.45 Impact Factor
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    ABSTRACT: To describe the medical and surgical management of noniatrogenic traumatic tracheobronchial injuries. From January 1993 to July 2004, 15 cases of traumatic tracheobronchial injury were treated in our department. The diagnosis was established by bronchoscopy and a computed tomography chest scan was performed on all patients. Surgical treatment was selected for patients with unstable vital signs, an open tracheal wound, associated esophageal lesions, progression of subcutaneous or mediastinal emphysema, mediastinitis or suspicious mediastinal secretions on imaging tests, or difficulties with mechanical ventilation due to the traumatic tracheobronchial injury. The mean (SD) age of the patients was 35.5 (18.9) years and 12 (80%) were male. Of the 15 cases, 13 (86.7%) had penetrating trauma and 2 (13.3%) blunt trauma. The most common location of the injury was in the bronchi (9 cases; 60%), followed by the cervical trachea (4 cases; 26.6%), followed by both the thoracic trachea and bronchi (2 cases; 13.4%). The most common initial symptom was subcutaneous emphysema, which presented in 11 (73.3%) patients. Chest (12 cases; 86.7%) and orthopedic injuries (9 cases; 60%) were the most common associated injuries. Surgery was the treatment of choice in 11 (73.3%) cases and conservative medical treatment in 4 (26.7%). An irreversible brain injury caused the death of 1 patient receiving conservative treatment. Tracheobronchial injuries may be treated conservatively if they meet strict selection criteria. Size and location should not be used as selection criteria for surgical treatment.
    Archivos de Bronconeumología 06/2005; 41(5):249-54. · 1.82 Impact Factor
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    ABSTRACT: Objetivo: Describir el manejo médico-quirúrgico de las lesiones traqueobronquiales traumáticas no iatrogénicas. Pacientes y método: De enero de 1993 a julio de 2004 se registraron en nuestro servicio 15 casos de lesiones traqueobronquiales traumáticas. En todos los pacientes el diagnóstico se estableció por broncoscopia y a todos se le realizó una tomografía computarizada de tórax. Se eligió tratamiento quirúrgico cuando había inestabilidad vital del paciente, herida traqueal abierta, lesiones esofágicas asociadas, progresión de enfisema subcutáneo o mediastínico, mediastinitis o colecciones mediastínicas sospechosas en pruebas de imagen o dificultades en la ventilación mecánica por la lesión traqueobronquial traumática. Resultados: La edad media (± desviación estándar) de los pacientes fue de 35,5 ± 18,9 años y 12 (80%) eran varones. Se registraron 13 traumatismos cerrados (86,7%) y 2 abiertos (13,3%). La localización más frecuente de la lesión fue bronquial (9 casos; 60%), seguida de tráquea cervical (4 casos; 26,6%) y tráquea toracicobronquial (2 casos; 13,4%). El síntoma inicial más frecuente fue el enfisema subcutáneo, que presentaron 11 pacientes (73,3%). Las lesiones asociadas más frecuentes fueron torácicas, con 12 casos (86,7%), seguidas de ortopédicas, con 9 (60%). El tratamiento de elección fue quirúrgico en 11 casos (73,3%) y médico conservador en 4 (26,7%). Falleció una paciente tratada de forma conservadora por lesión cerebral irreversible. Conclusiones: Las lesiones traqueobronquiales pueden tratarse de forma conservadora si cumplen criterios estrictos de selección. El tamaño o la localización no debe ser un criterio para la elección del tratamiento quirúrgico.
    Archivos de Bronconeumología 05/2005; · 1.82 Impact Factor
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    ABSTRACT: To study the specific importance of mediastinal staging in women with nonsmall cell lung cancer. Between July 1981 and September 2003 we surgically staged 2172 patients with nonsmall cell lung cancer who met the inclusion criteria for resectability and operability. A subgroup of 108 women was studied. Cervical mediastinoscopy was performed in all cases, with the addition of anterior mediastinotomy in cases with left upper lobe involvement. All patients underwent a preoperative computed tomography chest scan. Cervical mediastinoscopy was performed on all 108 patients, 26 of whom also underwent anterior mediastinotomy. Positive findings were recorded in 44 (40.7%) of the 108 cases: 39 of the 108 mediastinoscopies (36.1%), 9 of the 26 mediastinotomies (34.6%), and in 5 cases (19.2%) both mediastinoscopy and mediastinotomy. Nodal involvement was found in 13% of cases in clinical stage IA and 30.8% of cases in clinical stage IB. The percentage of positive findings was significantly higher for cases with adenocarcinoma or large cell carcinoma (P<.05). We performed 67 thoracotomies: 46 patients underwent lobectomy (42.6% of the 108), 7 bilobectomy (6.5%), 9 pneumonectomy (8.3%), and 5 exploratory thoracotomy (4.6%). The agreement between clinical staging after mediastinoscopy and pathological staging after thoracotomy was 47% (stage IA) and 57% (stage IB). Routine mediastinoscopy is indicated for all women with nonsmall cell lung cancer, regardless of clinical stage.
    Archivos de Bronconeumología 03/2005; 41(3):125-9. · 1.82 Impact Factor
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    ABSTRACT: Objetivo: Investigar la importancia específica de la estadificación mediastínica de mujeres con carcinoma broncogénico, no microcítico. Pacientes y métodos: Entre julio de 1981 y septiembre de 2003 estadificamos quirúrgicamente a 2.172 pacientes con carcinoma broncogénico no microcítico que cumplían criterios de resecabilidad y operabilidad. Se realizó mediastinoscopia cervical de forma habitual, y mediastinotomía anterior en caso de afectación del lóbulo superior izquierdo. Todos los pacientes tenían una tomografía axial computarizada de tórax preoperatoria. Se estudió al subgrupo de 108 mujeres. Resultados: Realizamos mediastinoscopia cervical en 108 casos y mediastinotomía anterior en 26. Fueron positivas 44 (40,7%) --39 (36,1%) mediastinoscopias, 9 (34,6%) mediastinotomías y en 5 (19,2%) casos ambas--. Se objetivó afectación ganglionar en un 13% de los casos en estadio IA y en un 30,8% en estadio IB. El porcentaje de positividad fue significativamente mayor en caso de adenocarcinoma o carcinoma de células grandes (p < 0,05). Realizamos 67 toracotomías: 46 (42,6%) lobectomías, 7 (6,5%) bilobectomías, 9 (8,3%) neumonectomías y 5 (4,6%) toracotomías exploradoras. La concordancia entre estadificación clínica posmediastinoscopia y patológica postoracotomía fue del 47% (IA) y del 57% (IB). Conclusiones: La mediastinoscopia sistemática está indicada en todas las mujeres con carcinoma broncogénico no microcítico independientemente del estadio clínico.
    Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax (ALAT), ISSN 0300-2896, Vol. 41, Nº. 3, 2005, pags. 125-129. 01/2005;
  • P Ausín Herrero, A Gómez-Caro Andrés, F J Moradiellos Díez
    Archivos de Bronconeumología 01/2005; 40(12):603. · 1.82 Impact Factor
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    ABSTRACT: Postoperative chylothorax after lung resection is a major problem leading to morbidity and mortality and requiring reoperation in a large number of cases. The most advisable and least aggressive option is conservative management in progressive stages: a diet rich in medium-chain fatty acids and/or total parenteral nutrition, in addition to chest tube drainage. Including octreotide in this regimen seems to be related to a higher success rate without the need for surgery. We report a case in which the effectiveness and safety of octreotide in the resolution of postoperative chylothorax was excellent.
    Archivos de Bronconeumología 11/2004; 40(10):473-5. · 1.82 Impact Factor
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    ABSTRACT: We report a case of epidural extension of pleural empyema with cord compression and neurologic deficit. Surgical decompression was required and emergency bilateral laminectomy was performed with removal of abscess and granulation tissue. Methicillin-resistant Staphylococcus aureus grew in cultures of pleural and epidural specimens and appropriate intravenous antibiotics were started. In spite of early diagnosis and rapid management the patient suffered severe sequelae.
    Interactive Cardiovascular and Thoracic Surgery 07/2004; 3(2):317-8. · 1.11 Impact Factor
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    ABSTRACT: El quilotórax posquirúrgico tras resección pulmonar es un problema importante por su morbimortalidad y suele obligar a la reintervención en un porcentaje importante de los casos. La opción más aconsejable y menos radical es el tratamiento conservador con medidas escalonadas: dieta rica en ácidos grasos de cadena media y/o nutrición parenteral total, además de tubo de toracostomía. El uso del octreótido entre estas medidas parece estar relacionado con un índice mayor de resolución sin necesidad de un tratamiento quirúrgico. Presentamos un caso en que su efectividad e inocuidad en la resolución del quilotórax posquirúrgico fue excelente.
    Archivos de Bronconeumología 01/2004; · 1.82 Impact Factor