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Comment to the article: Diaphragmatic patch: A useful adjunct in surgical treatment of recurrent catamenial hemothorax
Comentário ao artigo: Penso diafragmático: um auxiliar útil para o tratamento cirúrgico de hemotórax recorrente catamenial
J.M. Borro
Thoracic Surgery, Universitary Hospital A Coruña, A Coruña, Spain
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(B) Goretex patch repair of fenestrations.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Nwiloh" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Nwiloh" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215911000705?idApp=UINPBA00004E" "url" => "/08732159/0000001700000006/v2_201509041318/S0873215911000705/v2_201509041318/en/main.assets" ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comment</span>" "titulo" => "Comment to the article: Diaphragmatic patch: A useful adjunct in surgical treatment of recurrent catamenial hemothorax" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "281" "paginaFinal" => "282" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "J.M. Borro" "autores" => array:1 [ 0 => array:3 [ "nombre" => "J.M." "apellidos" => "Borro" "email" => array:1 [ 0 => "jbormat@sergas.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Thoracic Surgery, Universitary Hospital A Coruña, A Coruña, Spain" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Comentário ao artigo: Penso diafragmático: um auxiliar útil para o tratamento cirúrgico de hemotórax recorrente catamenial" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The present work reviews the catamenial hemothorax and its relation to two potential clinical cases.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Hemothorax is a condition usually associated to thoracic trauma, iatrogenesis, pneumothorax, and malignant or infectious pleural disease. Apart from these clinical entities, the presence of hemothorax is not frequent and its etiology is usually difficult to ascertain. Thoracic endometriosis<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> is one of the rare entities that can be responsible for the presentation of a hemothorax, and the diagnosis is relatively easy when endometriosis foci are found within the thoracic cavity. More frequently, hemothorax is clinically diagnosed in female patients with abdominal endometriosis presenting pneumothorax and/or hemothorax associated with the end phase of the menstrual cycle.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Other cases are usually labelled as idiopathic cases.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Regarding the treatment, the use of drainage alone can be sufficient; as a matter of fact, autologous blood was injected in the pleural space as the treatment for pneumothorax since it facilitates the development of pleural adherences.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Cleaning of pleural cavity through videothoracoscopy, combined with pleural and diaphragmatic abrasion, could facilitate the diagnosis and, at the same time, solve the problem.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> In case of relapse, total or partial parietal pleurectomy could be a more aggressive option for the management of this entity. In every case, pleural examination and lung palpation should be done in order to identify the presence of lung bullas, endometriosis foci or nodules that should be resected for diagnosis and treatment purposes. The diaphragm should be carefully inspected for the identification and closure with suture of orifices that can be occasionally found.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Talc produces intense adherences in the pleura, and its use is recommended for the treatment of malignant pleural effusions as palliative treatment. However, talc poudrage was considered an absolute contraindication to lung transplant. Nowadays, the International Society of Heart and Lung Transplantation still consider talc poudrage as a very high surgical and postoperative risk factor.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> All of us who have performed transplant surgery in patients previously treated with talc pleurodesis know the intense pleural reaction against talc, which can be especially problematic when fibrosis affects vascular and mediastinal structures. The use of talc in patients of 30–40 years of age who may require a transplant or any other thoracic surgical intervention in the future should be approached with great caution.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In these cases the reconstruction of the diaphragm with a Gore-Tex patch has been effective,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">7</span></a> but it is a very arduous task, expensive and, probably unnecessary, especially when no transdiaphragmatic orifices or significant diaphragmatic pathology are observed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The end may justify the use of exceptional means in, especially, complex cases, but it never justifies the recommendation of those means as routine treatment.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, we should always be extremely thorough in the fulfilment of diagnostic criteria and very cautious when we use or recommend therapeutic procedures that are not yet well established or are not free from future complications.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracic endometriosis: an unusual cause of hemothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. 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Poggi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1510/icvts.2009.231241" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2010" "volumen" => "10" "paginaInicial" => "923" "paginaFinal" => "925" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20299446" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International Guidelines for the Selection of Lung Transplant Candidates: 2006 Update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.B. Orens" 1 => "M. Estenne" 2 => "S. Arcasoy" 3 => "J.V. Conte" 4 => "P. Corris" 5 => "J.J. Egan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2006.03.011" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2006" "volumen" => "25" "paginaInicial" => "745" "paginaFinal" => "755" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16818116" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0040" "etiqueta" => "[7]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diaphragmatic patch: A useful adjunct in surgical treatment of recurrent catamenial hemothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Nwiloh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rppneu.2011.06.006" "Revista" => array:6 [ "tituloSerie" => "Rev Port Pneumol" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "278" "paginaFinal" => "280" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21795017" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08732159/0000001700000006/v2_201509041318/S0873215911001176/v2_201509041318/en/main.assets" "Apartado" => array:4 [ "identificador" => "9596" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Comentário" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001700000006/v2_201509041318/S0873215911001176/v2_201509041318/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215911001176?idApp=UINPBA00004E" ]
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| 2014 April | 40 | 7 | 47 |
| 2014 March | 63 | 12 | 75 |
| 2014 February | 48 | 9 | 57 |
| 2014 January | 50 | 7 | 57 |
| 2013 December | 55 | 9 | 64 |
| 2013 November | 67 | 15 | 82 |
| 2013 October | 47 | 12 | 59 |
| 2013 September | 37 | 12 | 49 |
| 2013 August | 61 | 15 | 76 |
| 2013 July | 71 | 19 | 90 |
| 2013 June | 45 | 10 | 55 |
| 2013 May | 49 | 14 | 63 |
| 2013 April | 51 | 19 | 70 |
| 2013 March | 51 | 9 | 60 |
| 2013 February | 43 | 18 | 61 |
| 2013 January | 46 | 14 | 60 |
| 2012 December | 27 | 10 | 37 |
| 2012 November | 30 | 20 | 50 |
| 2012 October | 25 | 3 | 28 |
| 2012 September | 14 | 11 | 25 |
| 2012 January | 231 | 0 | 231 |
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