Carta al Director
Respuesta de los autores
Author's Reply
Maria Deu-Martín
Servicio de Cirugía Torácica, Hospital Universitario Vall d’Hebron, Barcelona, España
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"tieneTextoCompleto" => true "saludo" => "Sr. Director:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "611" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Maria Deu-Martín" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Maria" "apellidos" => "Deu-Martín" "email" => array:1 [ 0 => "mdeumartin@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario Vall d’Hebron, Barcelona, España" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Author's Reply" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">Tal como refieren los autores de la carta<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a>, la elección del abordaje quirúrgico sigue siendo un tema en controversia, acentuado por la escasa casuística que existe en la literatura. Algunos autores abogan por abordajes poco invasivos: drenaje percutáneo<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a>, mediastinotomía anterior<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a> o videotoracoscopia<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a>. Otros autores desaconsejan<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a> estas vías, ya que las consideran incompletas o inadecuadas.</p><p id="p0010" class="elsevierStylePara elsevierViewall">Durante los 11 años de nuestro estudio, cada cirujano ha elegido la vía de abordaje buscando la mayor rentabilidad y seguridad, y para nosotros la toracotomía posterolateral es la incisión que ofrece el mejor campo quirúrgico (aunque en su contra, precisa de decúbito lateral durante la intervención, una posición mal tolerada en un paciente comprometido y provoca un patrón restrictivo por dolor en el postoperatorio). Los resultados de Misthos et al<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a> avalan nuestra decisión, ya que obtienen una supervivencia del 91% cuando realizan un desbridamiento mediante cervicotomía y toracotomía, y una mortalidad del 50% cuando solo se efectúa una cervicotomía.</p><p id="p0015" class="elsevierStylePara elsevierViewall">De todas formas, como comentan los autores de la carta, el objetivo final de la cirugía es el desbridamiento de los abscesos y la colocación de sondas que permitan el drenaje mantenido, por lo que la elección de la vía va a depender en muchos casos de las experiencias del cirujano en relación a esta patología.</p><p id="p0020" class="elsevierStylePara elsevierViewall">Pero sí queremos hacer hincapié en que la mediastinitis necrosante descendente es una enfermedad potencialmente letal que precisa de un tratamiento multidisciplinar y agresivo para reducir su mortalidad y la vía de acceso debe proporcionar una visión excelente, que permita un desbridamiento amplio y que evite lesiones innecesarias de los órganos, vasos y nervios que allí se hospedan.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bb0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Honguero Martínez AF, Alberto Rombolá C, León Atance P. 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Sadiq" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bjoms.2005.09.003" "Revista" => array:6 [ "tituloSerie" => "Br J Oral Maxillofac Surg" "fecha" => "2006" "volumen" => "44" "paginaInicial" => "538" "paginaFinal" => "542" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16233941" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of descending necrotizing mediastinitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Makeieff" 1 => "N. Gresillon" 2 => "J.P. Berthet" 3 => "R. Garrel" 4 => "L. Crampette" 5 => "C. Marty-Ane" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005537-200404000-00035" "Revista" => array:7 [ "tituloSerie" => "Laryngoscope" "fecha" => "2004" "volumen" => "114" "paginaInicial" => "772" "paginaFinal" => "775" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15064640" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0001731010004916" "estado" => "S300" "issn" => "00017310" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is video-assisted thoracoscopic surgery an optimal approach for descending necrotizing mediastinitis?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Endo" 1 => "T. Hasegawa" 2 => "Y. Sato" 3 => "Y. Sohara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2004.02.135" "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2005" "volumen" => "79" "paginaInicial" => "751" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15680891" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Descending necrotizing anterior mediastinitis: analysis of survival and surgical treatment modalities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Misthos" 1 => "S. Katsaragakis" 2 => "S. Kakaris" 3 => "D. Theodorou" 4 => "I. Skottis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.joms.2006.06.287" "Revista" => array:6 [ "tituloSerie" => "J Oral Maxillofac Surg" "fecha" => "2007" "volumen" => "65" "paginaInicial" => "635" "paginaFinal" => "639" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17368356" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000004600000011/v1_201305150303/S0300289610002553/v1_201305150303/es/main.assets" "Apartado" => array:4 [ "identificador" => "9222" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director / Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000004600000011/v1_201305150303/S0300289610002553/v1_201305150303/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289610002553?idApp=UINPBA00003Z" ]
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