Conference coverage: Bolivian Society of Cardiac, Thoracic and Vascular Surgery

Notes from the day’s lectures at the XVI Congreso Boliviana de Cirugia Cardiaca, Toracica u Vascular in Santa Cruz de la Sierra, Bolivia

This afternoon’s thoracic surgery offerings were provided in a more relaxed, round-table style discussion.

Relaxed roundtable discussion – Latin American surgeons. (Dr. Fernando Bello is the second from the left)

Dr. Edwin Crespo Mendoza, thoracic surgeon, of Santa Cruz, Bolivia led the discussion on diaphragmatic hernia repair and reminded the audience that over 50% of traumatic diaphragmatic hernias go undiagnosed at the time of initial presentation after trauma.  To illustrate this, Dr. Crespo presented several cases including a case of post-traumatic hernia diagnosed 13 years after initial auto accident.

successful diaphragmatic hernia repair – click to enlarge

Dr. Fernando E. Jemio Ojara, MD (cardiothoracic surgeon) here in Santa Cruz at the Clinica Folanini presented a fascinating case of bilateral lung injury after blunt trauma.  In this case, the patient was preparing to undergo urgent repair of a right-sided bronchial tear but during attempted intubation saturations dropped dramatically to 60%.  At that time, the patient was placed on ECMO by venous cannulation to maintain oxygenation during the case.   The surgeons proceeded with a right posteriolateral thoracotomy.  Patient had a short successful ECMO run of 85 minutes, with extubated within 36 hours of surgery, and had no further problems post-operatively,

Dr. Ojara also discussed the mechanism of these type of acceleration – deceleration injuries that most commonly affect the right middle lobe, and how stabilization with ECMO is an effective strategy to repair what is essentially a functional pneumonectomy (in this particularly patient).

Dr. Fidel Silva Julio, Thoracic Surgeon also talked on a similar theme in his overview of closed chest trauma.  He reminded the audience that 75-85% of all closed chest trauma patients need some sort of surgical management from chest tube placement to urgent surgery.  He  reviewed the classic presentations and radiographic findings in some of the most common conditions after chest trauma such as tension pnuemothorax/ sucking chest wounds, flail chest, pneumomediastinum, cardiac tamponade and pulmonary contusions.  There were several medical students in the audience, taking notes – so I have included links to the radiology signs mentioned in his lecture, as well as a basic radiology primer.

He also highlighted the need to prevent the typical trauma pitfall of massive volume resuscitation which can prove extremely detrimental in these patients.

More Radiology References

Pericardial effusion

Hamman sign – pneumomediastinum

with surgeons from La Paz, Bolivia

Upcoming conference: Robotic & minimally invasive surgery

Cirugia de torax prepares to head to Chile for the latest in Robotics and Minimally-invasive surgery

 

An upcoming one-day conference on Robotic surgery techniques and single port thoracic surgery in Santiago, Chile.

Interested surgeons may register here.

Talking with Dr. Raimundo Santolaya, MD, thoracic and transplant surgeon at the Instituto Nacional del Torax

an interview with thoracic and tranplant surgeon, Dr. Raimundo Santolaya Cohen of Santiago, Chile

Dr. Raimundo Santolaya, Thoracic and Transplant Surgeon

After listening to Dr. Raimundo Santolaya Cohen at the National Conference, where he discussed the diagnosis and management of Pneumothoraces, I immediately contacted him following the lecture to arrange an interview.  I was delighted to be able to spend several hours in the charismatic and elegant Chilean surgeon’s company while we talked about thoracic surgery, and the state of lung transplant in Chile.

Dr. Raimundo Santolaya, is a Valparaiso native who currently practices in Santiago at the Instituto Nacional del Torax and the Clinica Alemana.  He is also a professor and the Chief of the thoracic surgery fellowship program at the Universidad de Chile.

While he reports that while lung transplant programs are fairly small in Chile (in comparison to American institutions) he performs several transplants every year.

In addition to his interest in pulmonary transplant, he is also keenly interested in minimally invasive surgery, including uni-port surgery.  In fact, he is currently arranging for Dr. Diego Gonzalez, the Spanish thoracic surgeon to come to Chile in October to teach uni-port lobectomy.

Like most thoracic surgeons, he performs a wide range of thoracic procedures including lung surgeries, and mediastinal masses.

We also discussed the incidence of Hidatidosis/ hydatidosis, (echinococcus granulosus) which is endemic in Chile.  Hidatidosis is an infection caused by a parasite transmitted by animals (commonly dogs), and is more commonly known as a tapeworm.  Infection with this organism can affect multiple organs, but frequently affects the liver and the lungs, called hepatopulmonary hydatidosis.  Infection is marked by the development of hydatid cysts which are filled with tapeworm larvae.  In the lungs, these cysts can become quite large.

When this occurs, the cysts must be surgically excised in addition to aggressive medical management.

About Dr. Santolaya:

Dr. Raimundo Santolaya completed his thoracic surgery fellowship at the Universidad de Chile before traveling to Madrid, Spain to study lung transplant for an additional year.

Instituto Nacional del Torax

J. M. Infante 717, 4th floor

Santiago, Chile

Telephone (56-2) 340 3462

Clinica Alemana

Manquehue Norte 1410

Centro de Diagnostico, 11th floor

Santiago, Chile

Telephone (56-2) 210 1114