RESUMEN
OBJECTIVES: Postoperative recurrent primary spontaneous pneumothorax (PSP) is a troublesome complication and an important issue to be discussed. This study is to determine whether Re-video assisted thoracoscopic surgery (VATS) should be performed for postoperative recurrent PSP (PORP). MATERIALS AND METHODS: Patients who had underwent needlescopic VATS for PSP between Jan. 2007 and Dec. 2011 were reviewed. RESULTS: VATS was initially performed on 239 patients with PSP in total. Eleven patients were found to have PORP during a follow-up period of 36.95 months. Nine patients received Re-VATS and only two patients receiving conservative treatment had no further recurrence. No conversion to thoracotomy, blood transfusion and prolong air leak were recorded. CONCLUSIONS: Even for smaller size cases, Re-VATS, which is technically feasible, safe and effective with better cosmetics and minor postoperative pain, should be a strong contender as priority treatment.
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BACKGROUND: Lung ischemia-reperfusion (I/R) injury plays an important role in lung transplantation. Less well known is the role of sildenafil in lung I/R injury; therefore, we attempted to determine whether sildenafil could alleviate lung apoptosis and tissue injury in a rat model. METHODS: Forty male Sprague-Dawley rats were randomized into four groups: saline + sham, saline + I/R, sildenafil + sham, and sildenafil + I/R groups. Three hours before the operation, each rat received normal saline or sildenafil (10 mg/kg) by lavage. The animals designed to I/R injury were subjected to 2 h of ischemia induced by occlusion of left pulmonary artery, veins, and bronchus, followed by reperfusion for 2 h. The lung tissue was harvested for the analysis of the expression of Bax, Bcl-2, p53, caspase 3, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and wet/dry (W/D) weight ratio. RESULTS: Compared with the saline + sham group, the saline + I/R group had significant increases in Bax, p53, Bax/Bcl-2 ratio, caspase 3, IL-6, TNF-α, and W/D weight ratio but a decrease in Bcl-2 (P < 0.05). Compared with the saline + I/R group, sildenafil + I/R group had significant decreases in Bax, p53, Bax/Bcl-2 ratio, caspase 3, IL-6, TNF-α level, and W/D weight ratio but an increase in Bcl-2 expression (P < 0.05). Compared with the sildenafil + sham group, there were significant increases in p53 and TNF-α expression in the sildenafil + I/R group (P < 0.05). CONCLUSIONS: Pretreatment with sildenafil alleviates lung apoptosis and tissue injury in a rat model.
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Pulmón/irrigación sanguínea , Piperazinas/farmacología , Circulación Pulmonar/efectos de los fármacos , Daño por Reperfusión/tratamiento farmacológico , Sulfonas/farmacología , Vasodilatadores/farmacología , Animales , Apoptosis/efectos de los fármacos , Caspasa 3/metabolismo , Modelos Animales de Enfermedad , Interleucina-6/metabolismo , Pulmón/efectos de los fármacos , Pulmón/metabolismo , Trasplante de Pulmón , Masculino , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Purinas/farmacología , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , Citrato de Sildenafil , Factor de Necrosis Tumoral alfa/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Proteína X Asociada a bcl-2/metabolismoRESUMEN
Whether the outcome of primary spontaneous pneumothorax (PSP) when treated with needlescopic video-assisted thoracic surgery is positive is still under scrutiny. The present study was conducted to compare the needlescopic approach with the conventional approach. One-hundred and six patients with primary spontaneous pneumothorax who had undergone needlescopic video-assisted thoracic surgery (NVATS) between May 2006 and August 2008 were reviewed. Their age, gender, smoking status, BMI, side of attack, operative indications, operative time, intraoperative blood loss, postoperative length of stay, postoperative pain in visual analog scale (VAS), postoperative recurrence and follow-up period were recorded. These data were compared with those of 89 patients with PSP who had undergone conventional video-assisted thoracic surgery (CVATS) between June 2002 and April 2006. The operative time was shorter (NVATS: 82.36 ± 35.58 min, CVATS: 99.78 ± 35.74 min; p = 0.008) and intraoperative blood loss was less (NVATS: 16.67 ± 25.90 ml, CVATS: 24.36 ± 26.86 ml; p = 0.04) for the NVATS group. The postoperative pain in VAS was significantly less in NVATS. No major complication or mortality was found in either group. For treatment of primary spontaneous pneumothorax, NVATS is a safe and effective option. Further, it has the added benefit of less pain and improved cosmetics.
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Neumotórax/cirugía , Cirugía Torácica Asistida por Video/instrumentación , Femenino , Humanos , Masculino , Dolor Postoperatorio , Estudios Retrospectivos , Estadística como Asunto , Cirugía Torácica Asistida por Video/estadística & datos numéricos , Adulto JovenRESUMEN
Most aorto-respiratory fistulas are related to aortic pathology or procedures, but fistula formation after esophageal resection has never been reported in the literature. We are now reporting a case of hemoptysis that occurred after esophagectomy for locally advanced esophageal cancer. Aortobronchial fistula was detected by computed tomography scan. The patient was finally saved by emergency surgery-Dacron graft interposition of the descending thoracic aorta. There was no malignant cell in the postoperative specimen of the fistula. The erosion of the ligaclips (Johnson & Johnson) might be responsible for the aortobronchial fistula formation. For esophageal surgery, avoidance of trauma to aortic wall and careful using of ligaclips are important to circumvent this complication.
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Aorta Torácica/patología , Fístula Bronquial/etiología , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Fístula Vascular/etiología , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aorta Torácica/diagnóstico por imagen , Fístula Bronquial/diagnóstico por imagen , Broncoscopía , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Fístula Vascular/diagnóstico por imagenRESUMEN
OBJECTIVES: The aim of this study was to identify the preoperative factors that affect the survival of patients who undergo esophagogastrectomy after corrosive ingestion, using analysis of their physiological condition, associated diseases, physical examination, and laboratory data. METHODS: Between January 1995 and December 2005, 71 consecutive patients who underwent esophagogastrectomy for corrosive ingestion injuries were retrospectively reviewed. Of them, 41 survived and 30 (42.3%) died during the perioperative period. Logistic regression analyses were used to model markers for postoperative mortality, including descriptive data, clinical symptoms/signs, and laboratory data. RESULTS: There were 35 males and 36 females included in the study, with an average age of 54.7 +/- 14.9 years. After adjustments in the logistic regression model, age of over 65 years (p = 0.021), presence of gross hematuria (p = 0.016), twofold level of serum AST (p = 0.012), blood pH level below 7.2 (p = 0.017), and deficit of blood base over 16 (p = 0.007) were found to be independent risk factors for patient mortality. CONCLUSIONS: We consider age over 65 years, preoperative pH < 7.2, base deficit >16, twofold level of serum AST, and presence of gross hematuria to be the important factors predicting postoperative hospital mortality in patients presenting with corrosive ingestion injuries who require emergency surgery.
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Cáusticos/efectos adversos , Esofagectomía/mortalidad , Gastrectomía/mortalidad , Tracto Gastrointestinal/lesiones , Tracto Gastrointestinal/cirugía , Mortalidad Hospitalaria , Enfermedad Aguda , Adulto , Anciano , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: The prognosis and quality of life (QOL) for those with cervical esophageal cancer is extremely poor, and chemoradiotherapy remains the mainstay treatment. During the past few years, our surgical teams has implemented a more aggressive and radical resection: total laryngopharyngectomy with neck dissection, total esophagectomy, and reconstruction with stomach. This study compares the results of chemoradiotherapy and that of the aforementioned surgical approach. METHODS: This is a retrospective study of 15 patients who underwent radical resection and 14 patients who received chemoradiation. Their age, sex, tumor stage and grade, pre- and posttreatment dysphagia scores, operating time, blood loss, length of intensive care and postoperative stay, days to resume oral intake, complications, Eastern Cooperative Oncology Group (ECOG) status, QOL score, and disease-specific survival were recorded and compared. RESULTS: There were no significant differences in age, sex, pretreatment dysphagia score, cancer stage and grade, ECOG status (posttreatment), associate diseases, preoperative QOL, or follow-up period between the two groups. However, the posttreatment dysphagia score was significantly better for the operative group (P < 0.001). QOL improved in both groups, and the operative group seemed better although the difference was not significant. In addition, the survival between the two groups was statistically insignificant (P = 0.97, log-rank test). CONCLUSIONS: Our experience showed that radical surgery that includes total laryngopharyngectomy with neck dissection, total esophagectomy, and reconstruction with stomach for cervical esophageal cancer is beneficial to patients in terms of better eating.
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Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Adulto , Anciano , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/radioterapia , Distribución de Chi-Cuadrado , Terapia Combinada , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/radioterapia , Esofagectomía , Femenino , Humanos , Laringectomía , Masculino , Persona de Mediana Edad , Disección del Cuello , Estadificación de Neoplasias , Complicaciones Posoperatorias , Pronóstico , Calidad de Vida , Procedimientos de Cirugía Plástica , Estudios Retrospectivos , Estadísticas no Paramétricas , Estómago/trasplante , Toracotomía , Traqueostomía , Resultado del TratamientoRESUMEN
OBJECTIVES: More than 50% of patients with primary spontaneous pneumothorax have contralateral blebs/bullae, and about a quarter will develop a contralateral pneumothorax. The purpose of this prospective study was to determine the need for elective treatment of asymptomatic contralateral blebs/bullae in patients presenting with primary spontaneous pneumothorax. METHODS: From May 2006 through June 2008, results from 35 patients with ipsilateral primary spontaneous pneumothorax without contralateral blebs receiving unilateral video-assisted thoracic surgery, 35 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs receiving unilateral video-assisted thoracic surgery, and 16 patients with ipsilateral primary spontaneous pneumothorax receiving bilateral video-assisted thoracic surgery for positive contralateral blebs were collected. Their demographic and operating data were also recorded. RESULTS: There was no significant difference in age, gender, smoking percentage, body mass index (kg/m(2)), blood loss, and postoperative pain among groups. There was longer operative time and length of stay in group receiving bilateral surgery. Within the follow-up period of 16.68 +/- 9.91 months (median, 17.50), no recurrence on either lung was found in the group operated on both sides, while contralateral occurrence was found in 17.14% of the group with ipsilateral primary spontaneous pneumothorax with contralateral blebs receiving unilateral video-assisted thoracic surgery within the period of 18.15 +/- 8.07 months (median, 21). CONCLUSION: The study showed that the preemptive video-assisted thoracic surgery for the contralateral blebs/bullae effectively prevented the contralateral occurrence.
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Vesícula/cirugía , Enfermedades Pulmonares/cirugía , Neumotórax/cirugía , Cirugía Torácica Asistida por Video , Vesícula/diagnóstico por imagen , Distribución de Chi-Cuadrado , Femenino , Humanos , Tiempo de Internación , Enfermedades Pulmonares/diagnóstico por imagen , Masculino , Neumotórax/diagnóstico por imagen , Estudios Prospectivos , Reoperación , Prevención Secundaria , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND/AIMS: Transthoracic and transhiatal esophagectomy are two common procedures for esophageal cancer resection. Prospective studies comparing the two methods in Asian people are few. In addition, the data comparing their effects on the quality of life are lacking. METHODOLOGY: A prospective randomized study was conducted from January 2003. Patients of resectable esophageal cancer of comparable stage were allocated to undergo the transthoracic or transhiatal procedure in turn. They were all reconstructed with stomach interposition through the retrosternal route. Discharged patients were followed-up in the outpatient clinic. They were questioned on the topics of (i) severity of pain, (ii) ease of swallowing, (iii) satisfaction of daily activities, (iv) dependence on medications, (v) working ability, (vi) fatigue, (vii) appetite, (viii) sociality, (ix) happiness and (x) self respect, in the third, sixth and twelfth month. Also the demographic data, operative results and survival were recorded. RESULTS: Up to December 2006, eighty-seven patients of stage II and III, including 71 patients of middle third lesions and 16 lower third lesions were enrolled. The operation time was significantly longer, and the leakage rate was higher in the transthoracic group (Student's t-test and Fischer's exact test, respectively). However, intraoperative blood loss and postoperative hospital stay were not significantly different (Student t-test). Also, the Kaplan-Meier survival curves of these two groups were not significantly different by log-rank test (p=0.286). The score on the quality of life of transhiatal patients was significantly higher than that of transthoracic patients in the third, sixth and twelfth month. CONCLUSIONS: Transhiatal esophagectomy is a safe and fast procedure. The survival was similar to that of transthoracic approach. Its leakage rate was lower and quality of life was better.
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Pueblo Asiatico , Carcinoma/etnología , Carcinoma/cirugía , Neoplasias Esofágicas/etnología , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Adulto , Anciano , Carcinoma/mortalidad , Estudios de Cohortes , Neoplasias Esofágicas/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Calidad de Vida , Recuperación de la Función , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Minimally invasive surgery is the current trend of approach in various fields. Since May 2006, our team has started implementing needlescopic video-assisted thoracic surgery as the standard surgical treatment for primary spontaneous pneumothorax. During a seventeen-month period, 62 consecutive patients with primary spontaneous pneumothorax were operated on. The ages, sex ratio, operative times, blood loss, postoperative pain in visual analog scale (VAS), length of stay and hospital costs were recorded and compared with that of another 62 consecutive patients who received conventional video-assisted thoracic surgery between July 2004 and April 2006. Only the postoperative pain in VAS was significantly lower in the needlescopic video-assisted thoracic surgery group; the rest remained the same. Also the wounds were almost undetectable in the needlescopic video-assisted thoracic surgery patients. There were no major complications, mortality or recurrence in either group. Needlescopic video-assisted thoracic surgery is a high-tech technique which provides safety, effectiveness, economy and outcome comparable to that of conventional techniques. It is also associated with less pain and better cosmetics.
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Agujas , Neumotórax/cirugía , Cirugía Torácica Asistida por Video/métodos , Adolescente , Adulto , Femenino , Costos de Hospital , Humanos , Tiempo de Internación , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Dimensión del Dolor , Dolor Postoperatorio , Hemorragia Posoperatoria , Estudios Retrospectivos , Cirugía Torácica Asistida por Video/efectos adversos , Toracoscopios , Adulto JovenRESUMEN
Video-assisted thoracic surgery (VATS) is the treatment of choice for uncomplicated primary spontaneous pneumothorax (PSP). In this study, we design a modified thoracoscopic procedure and compare it with the standard VATS. Between January 2001 and July 2003, fifty-two consecutive patients with PSP were managed with the modified procedure, called video-assisted extrathoracic bleb excision (VAEB). Simultaneously, we reviewed and recorded the same data of another consecutive 52 patients who underwent standard VATS between April 1997 and December 2000. The two groups were compared regarding operative time, intraoperative blood loss, postoperative pain by visual analog scale (VAS), amount of chest tube drainage, length of hospital stay (LOS), and hospital cost. The age, gender, amount of chest tube drainage, and LOS were not significantly different (P = 0.787, 0.727, 0.660, and 0.602, respectively). The operative time was shorter (VAEB 43+/-6 min; VATS 63+/-5 min), pain was less (VAS: VAEB 6+/-1; VATS 7+/-1) and hospital cost was lower (VAEB dollars 1429+/-37; VATS dollars 2035+/-93) in the VAEB group. VAEB is an effective alternative procedure to standard VATS for PSP. It has the same effectiveness as VATS and catches the advantages of transaxillary minithoracotomy. In addition, it is an easier, quicker, less traumatic and more economical approach.
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Vesícula/cirugía , Neumotórax , Cirugía Torácica Asistida por Video/instrumentación , Tórax , Adulto , Femenino , Humanos , Masculino , Dolor Postoperatorio , Periodo Posoperatorio , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this study was to compare the outcomes of 3 different levels of sympathectomy. SUMMARY BACKGROUND DATA: Most surgeons still perform T(2) or T(2-3) sympathectomy for palmar hyperhidrosis, but both these treatments can cause severe side effects. Some recent articles have advocated T(4) sympathectomy and obtained satisfactory results. METHODS: Between January 2000 and August 2004, 234 records of patients treated for palmar hyperhidrosis were retrospectively reviewed. Of them, 86 patients were treated with endoscopic thoracic sympathectomy of T(2) (ETS(2)), 78 patients with ETS(3), and 70 patients with ETS(4). Follow-up data were collected using a telephone questionnaire with a scoring system. Multiple linear regressions were used to model markers for degree of satisfaction and severity of compensatory sweating (CS), including descriptive data, level of sympathectomy, clinical outcomes, and postoperative complications. RESULTS: Mean follow-up was 47.1 +/- 17.2 months. All 3 levels of sympathectomy could have achieved comparable improvement of palmar hyperhidrosis (P = 0.162). However, 88.5% of the patients noticed CS. Patients with ETS(4) presented the lowest incidence of CS (P = 0.030), had the least severity of CS (beta = -1.537, P = 0.002), and felt the least palmar overdryness (P < 0.001). None expressed regret for the procedure in the ETS(4) group (P = 0.022). Being obese did not increase the incidence of CS, but the severity of CS was directly related to body mass index (beta = 0.917, P < 0.001). The patients would be more satisfied if the severity of CS was minimal (beta = -0.185, P = 0.002). The degree of satisfaction may decrease with time (beta = -0.025, P = 0.003) and was lower when their palms were overdry (beta = -1.463, P < 0.001). CONCLUSIONS: Different from the current procedure of T(2) or T(3) sympathectomy for palmar hyperhidrosis, T(4) sympathectomy would be a better and more effective procedure with minimal long-term complications.
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Hiperhidrosis/cirugía , Metacarpo/inervación , Raíces Nerviosas Espinales/cirugía , Simpatectomía/métodos , Toracoscopía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Satisfacción del Paciente , Calidad de Vida , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: Primary spontaneous hemopneumothorax (PSHP) is a rare surgical emergency. The aim of this study was to compare the previous strategy of tube thoracostomy followed by thoracotomy when complications developed with early video-assisted thoracic surgery (VATS) for PSHP. METHODS: Between November 1989 and May 2005, a total of 24 consecutive patients with PSHP were retrospectively reviewed. Before January 2000, there were 13 patients who were subjected to the treatment strategy of initial tube thoracostomy and underwent operation if the condition deteriorated or later complications occurred (group T). Under this strategy, all of these patients later required operations. After January 2000, another 11 patients were treated with VATS as soon as their condition stabilized after tube thoracostomy and resuscitation (group V). The data for the two groups were compared: sex, age, involved side, initial heart rate (HR) and mean blood pressure (BP), initial hemoglobin (Hb), preoperative blood loss, operating time, amount of blood transfusion, period of chest tube drainage (POD), length of hospital stay (LOS), complications, and length of follow-up. RESULTS: The sex, age, involved side, and the initial HR, BP, and Hb of the two groups were similar. The patients of group V had a significantly longer operating time [group V, 111 minutes (mean); group T, 85 minutes, P = 0.002]; less preoperative blood loss (group V, 946 ml; group T, 1687 ml, P = 0.003); less blood transfusion (group V, 465 ml; group T, 1044 ml, P = 0.002); shorter POD (group V, 4 days; group T, 7 days, P = 0.011); and shorter LOS (group V, 5 days; group T, 10 days, P = 0.002). No mortality or recurrence was noted in the entire series. CONCLUSIONS: Our study suggests that surgery should be undertaken for PSHP as soon as possible after the clinical condition has stabilized. Under this strategy, VATS is an acceptable approach. It allows a shorter hospital stay and is exempt from unnecessary blood transfusion. Later complications, such as empyema and impaired lung reexpansion, can also be avoided.
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Hemoneumotórax/cirugía , Cirugía Torácica Asistida por Video , Adulto , Femenino , Humanos , Tiempo de Internación , Masculino , Estudios Retrospectivos , Toracostomía , Toracotomía , Resultado del TratamientoRESUMEN
BACKGROUND: Although the determination of the correct ganglion under direct vision through thoracoscopy by an experienced surgeon is almost unerring, there is still a 4.3% rate of clipping at the unintended level. METHODS: Through the review of the most recent patients (N = 117) with various sympathetic disorders undergoing thoracoscopic sympathetic interruption over different ganglions by clipping, we found that 5 cases were clipped at the unplanned level. The immediate manifestations were the different outcomes between both sides of the face, trunk, and extremities. The postoperative chest radiographs demonstrated the error. RESULTS: All patients received a second operation in which the unintended clip was removed, and a new one was applied to the appropriate ganglion. The results were satisfactory. CONCLUSIONS: Although the authors in this study have the experience of more than 1000 cases of hyperhidrosis, such an error is still inevitable. Luckily, by using the clipping method, the error is detectable and amendable.
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Ganglios Simpáticos/cirugía , Hiperhidrosis/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Instrumentos Quirúrgicos/normas , Toracoscopía/métodos , Desnervación/efectos adversos , Desnervación/instrumentación , Desnervación/métodos , Femenino , Lateralidad Funcional/fisiología , Ganglios Simpáticos/fisiopatología , Humanos , Hiperhidrosis/etiología , Hiperhidrosis/fisiopatología , Masculino , Complicaciones Posoperatorias/fisiopatología , Reoperación/instrumentación , Reoperación/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Instrumentos Quirúrgicos/efectos adversos , Instrumentos Quirúrgicos/estadística & datos numéricos , Cavidad Torácica/anatomía & histología , Cavidad Torácica/cirugía , Toracoscopía/efectos adversos , Toracoscopía/normas , Resultado del TratamientoRESUMEN
A total of 114 patients with various sympathetic disorders underwent endoscopic sympathetic block over different thoracic ganglions by the clipping method. The advantages of this method include the recognition of the clipped level, changeability, and reversibility. However, 4.4% of patients were unilaterally clipped at the wrong level.
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Enfermedades del Sistema Nervioso Autónomo/cirugía , Sonrojo , Ganglios Simpáticos/cirugía , Hiperhidrosis/cirugía , Adulto , Enfermedades del Sistema Nervioso Autónomo/complicaciones , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Endoscopía , Cara/inervación , Estudios de Seguimiento , Ganglios Simpáticos/fisiopatología , Mano/inervación , Humanos , Hiperhidrosis/etiología , Masculino , Reflejo Anormal , Prevención Secundaria , Sudoración , Resultado del TratamientoRESUMEN
Poorly controlled hypertension was incidentally cured after performing an endoscopic sympathetic block (ESB) in a patient with hyperhidrosis craniofacialis (HHC). A survey of the literature indicated that 30% to 40% of essential hypertension is of sympathetic origin. Patients with facial sweating associated with hypertension were then studied to determine whether blood pressure is lowered after performing ESB. Between November 2002 and July 2003, 17 hypertensive patients (13 males and 4 females) ranging in age from 22 to 62 years underwent ESB solely for HHC at the Department of Surgery of Kaohsiung Medical University, Taiwan. Their preoperative systolic blood pressure (SBP) values ranged from 170 +/- 6 to 200.7 +/- 7.6 mmHg, and their diastolic blood pressure (DBP) values ranged from 94.7 +/- 6.1 to 120.3 +/- 5.7 mmHg. Their heart rates were between 92.67 +/- 2.28 and 119.67 +/- 5.13 beats per minute (bpm). They were refractory to aggressive medical treatment, including lifestyle modifications and antihypertensive medications. Their postoperative blood pressure, heart rate and surgical outcomes were recorded. After performing ESB, HHC was cured in all 17 patients. Based on the reductions in blood pressure and heart rate, the patients could be divided into two groups, one showing high-level reductions (Group T) and one showing low-level reductions (Group S). The blood pressure of Group T (ten patients) was reduced to the range of 120.2 +/- 6.9 to 131.6 +/- 3.5 mmHg SBP and 74.8 +/- 3.1 to 85.4 +/- 4.5 DBP, and the heart rate of this group was reduced to the range of 65.36 +/- 4.63 to 85 +/- 3.60 bpm, while the blood pressure and heart rate of Group S (seven other patients) were reduced to the ranges of 145.9 +/- 5.7 to 160.5 +/- 5.5 mmHg SBP, 90 +/- 4 to 100.7 +/- 3.2 mmHg DBP, and 80 +/- 4 to 90.83 +/- 3.53 bpm, respectively. The patients in Group S were well controlled at 119.8 +/- 5.5 to 130.6 +/- 8.0 mmHg SBP and 70.1 +/- 3.8 to 84.5 +/- 5.7 mmHg DBP with a daily low-dose of calcium channel blocker. The average follow-up periods of the two groups were 17.00 +/- 2.906 and 17.43 +/- 2.37 months, respectively. We named this surgically curable form of hypertension "Sympathetic Hypertensive Syndrome" (SHS), which we define by the presence of all three of the following: 1) stage II hypertension; 2) HHC or other sympathetic disorders; and 3) heart rate > or = 100 bpm. If the patient is male the reductions of blood pressure after the surgery will be better, which might be due to the link with Y chromosome. Finally, we recommend that ESB should be performed in patients with SHS, although the female would respond less satisfactorily in terms of the blood pressure.
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Enfermedades del Sistema Nervioso Autónomo/complicaciones , Enfermedades del Sistema Nervioso Autónomo/cirugía , Hipertensión/etiología , Hipertensión/cirugía , Simpatectomía , Adulto , Presión Sanguínea , Femenino , Ganglios Simpáticos/cirugía , Frecuencia Cardíaca , Humanos , Hiperhidrosis/etiología , Hiperhidrosis/cirugía , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Compensatory hyperhidrosis (CH) is the most troublesome side effect after T2 sympathectomy for palmar hyperhidrosis (PH). The aim of this study was to evaluate whether T4 ganglion interruption for PH is an effective approach that can simultaneously minimize the rate of CH. Between July 2001 and July 2003, 84 PH patients undergoing bilateral thoracoscopic T4 sympathectomy were followed up in the outpatient clinic and by telephone questionnaire. Rates of success, regret, CH, recurrence, and complications were recorded. The follow-up period ranged from 18 to 42 months. All excessive hand sweating was stopped. Only two patients had mild CH that did not affect their daily activities. No patients had recurrence or regret. The only other complication was that four patients had postoperative minimal residual pneumothorax, which needed no treatment. All patients were satisfied with the outcome. T4 sympathectomy was an effective method to cure PH. The success rate was 100%. The rate of CH was remarkably low compared with T2 sympathetic ganglionic interruption.
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Hiperhidrosis/cirugía , Complicaciones Posoperatorias/prevención & control , Simpatectomía/métodos , Adolescente , Adulto , Femenino , Humanos , Masculino , Simpatectomía/efectos adversosRESUMEN
Video-assisted thoracoscopic surgery (VATS) has become a popular and well-refined procedure. It has several advantages over open thoracotomy in terms of invasiveness and cosmetics. The aim of this study is to consider if VATS can serve as primary management for pediatric empyema. Between October 2000 and December 2002, 13 children with empyema receiving VATS were retrospectively reviewed. Of them, 5 had tube thoracostomy before VATS intervention (group T), and 8 had VATS as the initial treatment (group V). Their mean (+/- SD) age of groups V and T were 5.75 +/- 4.43 and 4.0 +/- 1.58 years, respectively. The children of group V had a shorter length of hospital stay (group V 10.7 +/- 3.54 days; group T 28.2 +/- 8.32 days), a shorter period of chest tube drainage (group V 5 +/- 1.87 days; group T 25 +/- 11.08 days), less transfusion (group V 0.4 +/- 0.17 units; group T 0.9 +/- 0.27 units) and less radiation exposure (group V 10.3 +/- 3.49; group T 23.4 +/- 11.64). No mortality was noted in the entire series. We conclude that primary VATS is a safe, effective and definitive method which can serve as first-line therapy for children with empyema.
Asunto(s)
Empiema/cirugía , Toracoscopía , Cirugía Asistida por Video , Adolescente , Tubos Torácicos , Niño , Preescolar , Femenino , Humanos , Intubación Intratraqueal , Masculino , Estudios RetrospectivosRESUMEN
Transthoracic esophagectomy (TTE) and transhiatal esophagectomy (THE) are two common methods of resection for esophageal cancer. Although many studies have been performed in Western countries, there are still controversies over which method is the better procedure. In this study, postoperative improvement in dysphagia and the degree of postoperative pain were compared. The cases of 50 patients undergoing TTE and 23 undergoing THE for esophageal cancer between March 1997 and October 2002 were retrospectively reviewed. The location of the lesion, clinical stage (TNM), operative time, operative blood loss, hospital stay, complications, number of lymph nodes dissected, and survival duration were recorded. Pre- and postoperative dysphagia scores and postoperative pain perception (using a visual analog scale) were analyzed. Preoperative clinical stage and lesion site were not significantly different in the TTE and THE groups. The operative time was longer and the number of lymph nodes removed was larger in the TTE group. However, there were no differences in operative blood loss, hospital stay, complications, survival duration, and improvement in dysphagia. Pain perception in the THE group was significantly better than that in the TTE group. THE is a safe and rapid procedure, with recovery and survival periods similar to those for TTE. Both patient groups enjoyed the same ability to eat. Therefore, THE is an acceptable alternative to TTE for patients with middle- and lower-third esophageal cancer. Moreover, THE caused much less postoperative pain than TTE, which made patients more comfortable.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Neoplasias Esofágicas/cirugía , Adulto , Anciano , Trastornos de Deglución/etiología , Diafragma/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Complicaciones Posoperatorias , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The improvement in lung function, exercise test, blood gas levels, and symptoms in emphysema patients after volume reduction surgery is a result of improvements in breathing mechanics. The question is, is the improvement in the condition related to pulmonary hemodynamics? Few studies have examined pre- and postoperative pulmonary pressure. This paper examines whether there is any significant change in systolic and diastolic pulmonary pressure after effective volume reduction surgery. From October 1999 to October 2002, 12 emphysema patients who underwent volume reduction surgery were studied. Systolic and diastolic pulmonary pressures were measured 2 days before surgery through cardiac catheterization and 2 days after removal of the chest tubes through Swan Ganz catheters placed in the operating room just before surgery. Patients were stable and breathed without assistance during the postoperative pressure measurement. Blood gas analysis, lung function tests, and a 6-minute walk test were performed preoperatively and 3 months postoperatively. The two sets of data were compared using the Wilcoxon signed rank test. There was no significant change in pulmonary hemodynamics, although pulmonary function improved. The improvement in pulmonary function after volume reduction surgery is not related to pulmonary hemodynamics.