Hospitales San Roque Las Palmas GC


PULMONOLOGY


THORACIC SURGERY AND PULMONOLOGY


Respiratory diseases are a very common pathology in daily clinical activity. The number of patients in this field constantly increases, mainly due to tobacco consumption.

Pulmonology and thoracic surgery are parts of the medical specialities that deal with the respiratory system. The basic aim of pulmonology is the study, diagnosis, treatment, prevention and rehabilitation of respiratory diseases.

Thoracic surgery is a relatively modern speciality directly linked to pulmonology that encompasses the diagnosis and surgical treatment of thoracic diseases that affect the chest wall, pleura, lungs, trachea and bronchi, mediastinum, oesophagus and diaphragm.

Our department offers a comprehensive assessment of respiratory diseases through a medical assessment carried out by doctors specialized in this field. It also offers early and combined diagnostic and therapeutic procedures using pulmonary functional testing, video-assisted bronchoscopy, minimally-invasive surgery (video-assisted thoracoscopy) and open surgery that requires a short hospital stay.


SERVICES PROVIDED



A) CONSULTATION ON RESPIRATORY SYSTEM DISEASES:


• Chronic bronchitis or pulmonary emphysema due to tobacco intake, COPD

Their follow-up and early diagnosis is important both through medical consultation and through pulmonary function testing and bronchodilator treatment, and the emphasis must be put on smoking cessation and on advanced cases of oxygen therapy.

• Bronchial asthma


Bronchial asthma affects both children and adults. Allergic or extrinsic asthma has a high prevalence in the Canaries where dust mites play a significant role. On the other hand, asthma is becoming more common on our islands because of a characteristical meteorological phenomenon: the Sahara Air Layer, which is responsible for many relapses. Allergic rhinitis or more commonly called hay fever, which is closely linked to asthmatic patients, also plays a significant role in these patients.

• Diagnosis of pulmonary tumours


Lung cancer is nowadays the most common neoplasm and cause of death because of the malignant tumours, which are responsible for 28% of deaths due to cancer and 6% of all deaths. With this information, it is not difficult to justify the efforts that must be carried out to anticipate (anti-tobacco consultations) and to do an early and quick diagnosis of lung cancer. Hospitales San Roque has the necessary means to do so. They also now offer a new method for early diagnosis of lung cancer. If you are over 45 and a smoker for more than 15 years or an ex-smoker, you can benefit from a checkup to rule out lung cancer.

• Respiratory infections


Lung infections, whether bacterial, of the upper airway: rhinosinusitis, laryngitis, laryngotracheobronchitis, etc. and of the lower airway: bronchitis, pneumonia, etc. constitute another group of pathologies both in children and adults that are assessed in pulmonology consultations. These pathologies are especially prevailing during the autumn and winter.

• Sleep-disorder medicine

In this subfield, an assessment of patients who are suspected of suffering sleep apnoea is carried out, especially in usual snorers, who tend to be obese with excessive daytime sleepiness. This symptom conditions the patient to have a limited life, with a reduced physical and mental performance which determines a lower work performance and also an increased risk of diseases such as arterial hypertension and ischemic heart disease. This way, an early diagnosis and an adequate treatment mainly based on night non-invasive ventilation (Continuous Positive Airway Pressure) and health education will be a great benefit for these patients. There are alternative therapies such as mandibular prostheses, uvulopharyngoplasty, etc. that can be evaluated.
Hospitales San Roque has a team of expert neurophysiologists who perform the most useful diagnostic test for the condition which is polysomnography.

• Thoracic traumatisms and its complications

This field concentrates on the assessment and treatment of rib fractures, sternum fractures, traumatic haemopneumothorax, etc.

• Pleural effusion


Its origin can be infectious or malignant and it is a frequent reason for consultation that requires in most cases a combined diagnosis and treatment.

• Pneumothorax


Its origin can be spontaneous, traumatic or iatrogenic and is very common among our specialities. It can be cured with early minimally-invasive surgery the first time the patient is admitted, which reduces the number of relapses.

• Others

There are a great number of pathologies and conditions that can be assessed in the pulmonology and thoracic surgery consultations. Among them, the following stand out: interstitial pneumopathies, pulmonary vascular diseases, including pulmonary thromboembolism, pulmonary hypertension, vasculitides, work-place and occupational diseases and diseases linked to the environment, etc.

• Unit specialized in tobacco addiction

Tobacco addiction is extending to a growing number of citizens of which there are more and more young people, and the anti-tobacco units are an integral part of the assistance provided by lung specialists to their patients. Tobacco consumption is the first preventable cause of death in Spain. Every year 55,000 people die in our country because of tobacco consumption.

For this treatment, the latest diagnostic and therapeutic advances are used to stop smoking, with a strict monitoring, even telephone monitoring, during the treatment so as to reach the final aim which is to completely quit smoking. The participation of the doctor in the anti-tobacco programme considerably increases the rate of patients who have quit smoking, while without medical help, this rate is almost non-existent. Furthermore, an integral consultation with a specialized psychologist and an endocrinologic assessment are offered for weight monitoring if necessary.

• Unit specialized in pathological perspiration

Hyperdrosis or excessive sweating of palms, armpits or the face and head often lead patients to consult us in order to find a definite solution that can be botulinum toxin or minimally-invasive surgery (thoracic sympathectomy), which is latest generation technique at the disposal of the patients of Hospitales San Roque.
 

B) SURGICAL PROCEDURES


Among the minimally-invasive surgery procedures carried out by our department, the following stand out:

• Surgical treatment of excessive sweating (Hyperhidrosis) of the head and face, hands and armpits and with facial blushing: It is carried out under general anaesthesia and entails only a one-centimetre incision under each hemithorax. It is an outpatient procedure and the patient leaves the operating theatre without drainages.
• Surgical treatment of pneumothorax: It is carried out under general anaesthesia and consists in two to three one-centimetre incisions in the corresponding hemithorax.
• Resection of bullae surgery and lung volume reduction surgery for smoking patients with pulmonary emphysema: It is carried out under general anaesthesia and three one-centimetre incisions.
• Surgical exeresis of mediastinal tumours: It is carried out under general anaesthesia and three one-centimetre incisions.
• Thymectomy (thymus removal) in patients with Myasthenia Gravis or thymus tumours.
• Pleural biopsies to diagnose pleural pathology: It is carried out with local anaesthesia and sedation and only a one-centimetre incision. Furthermore, talk can be instilled into the pleural cavity to avoid pleural effusion.
• Lung biopsies to diagnose pulmonary pathology: It is carried out under general anaesthesia with two to three one-centimetre incisions.
• Correction of pectus excavatum (hallowed chest) by video-assisted thoracoscopy with the placement of a tailored steel bar under the sternum under general anaesthesia which will leave two small wounds in each hemithorax: It requires the use of an epidural catheter to provide analgesia in order to avoid pain after the surgery.

On the other hand, open surgery procedures are common:


• Resection of pulmonary metastases (presence of tumoural cells from tumours of other origins) in patients with the primary tumour controlled. It is carried out under general anaesthesia and with a submammary thoracotomy that hides the scar.
Lung resections such as lobectomy (removal of a lung lobe) or pneumonectomy (removal of the whole lung) in case of malignant lung tumours: It is carried out by making less aggressive amyotonic incisions or the placement of an epidural catheter with analgesia to avoid pain. This is often accompanied by the removal of all the lymph nodes (lymphadenectomy).
Chest wall stabilization after fractures and flail chest injuries in cases of patients with respiratory failure
• Pleuropulmonary decortication and cleansing to treat infections in the pleural cavity (empyemia)
• Mediastinal tumour removal (space between the lungs)
• Tracheal resection surgery in case of tumours or tracheal stenosis
• Intrathoracic thyroid surgery (intrathoracic goiter)


TECHNIQUES AND PROCEDURES


   
Non-invasive diagnostic tests:

• Spirometries and flow-volume curves, with particular emphasis on assessment of patients before and after surgery
• Bronchodilation test in patients studied for suspected bronchial asthma
• Studies of respiratory allergy: cutaneous hypersensitivity tests (prick-test) mainly carried out for the study of allergic or extrinsic asthma, RAST test (short for radioallergosorbent test)
• Plethysmography and measurement of static lung volumes with inert gases
• Diffusion of the alveoli to the pulmonary capillaries test
• Thoracic ultrasound: study of complicated pleural effusions, evaluation of pulmonary masses, etc.
• Physiopathological studies with exhaled nitric oxide as a state-of-the-art technique for early diagnosis of asthma: It is not available in other centres of the island.
• Analysis of respiratory gases in arterial and venous blood
• Polysomnography, cardiorespiratory polygraphy and continuous pulse oxymetry that can be carried out at the hospital or at home
• Capnography
• Induced sputum
• Co-oxymetry to accompany smoking cessation monitoring

Invasive diagnostic tests:

• Diagnostic and therapeutic thoracentesis
• Flexible bronchoscopy and its complementary techniques: bronchial and transbronchial biopsy with and without radioscopic monitoring, transbronchial needle puncture performed with a Wang needle, bronchoaspiration management, bronchial brushing and bronchoalveolar washing
• Transcutaneous or closed lung biopsy
• Pleuroscopy (thoracoscopy)

Non-invasive therapeutic techniques:

• Aerosol treatments
• Parenteral antibiotic treatments
• Specific immunotherapy (vaccines)
• Rehabilitation and respiratory physiotherapy techniques
• Treatments with non-invasive ventilation

Invasive therapeutic techniques:


• Pleural drainage
• Intrapleural fibrinolysis for infected pleural effusions
• Rigid bronchoscopy and its complementary techniques: endobronchial brachytherapy, endobronchial cryotherapy, endobronchial laser therapy, endobronchial electrocautery, endobronchial photodynamic treatments, endobronchial prosthesis implants, foreign body removal

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