Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 19 de 19
Filtrar
1.
Pulmonology ; 2024 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-39112109

RESUMEN

Lung cancer (LC) is a leading cause of cancer-related mortality worldwide. Lung Cancer Screening (LCS) programs that use low-dose computed tomography (LDCT) have been shown to reduce LC mortality by up to 25 % and are considered cost-effective. The European Health Union has encouraged its Member States to explore the feasibility of LCS implementation in their respective countries. The task force conducted a comprehensive literature review and engaged in extensive discussions to provide recommendations. These recommendations encompass the essential components required to initiate pilot LCS programs following the guidelines established by the World Health Organization. They were tailored to align with the specific context of the Portuguese healthcare system. The document addresses critical aspects, including the eligible population, methods for issuing invitations, radiological prerequisites, procedures for reporting results, referral processes, diagnostic strategies, program implementation, and ongoing monitoring. Furthermore, the task force emphasized that pairing LCS with evidence-based smoking cessation should be the standard of care for a high-quality screening program. This document also identifies areas for further research. These recommendations aim to guarantee that the implementation of a Portuguese LCS program ensures high-quality standards, consistency, and uniformity across centres.

3.
Cardiovasc Surg ; 7(3): 375-7, 1999 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-10386760

RESUMEN

Revascularization of the inferior side of the left ventricle is performed most often with aortocoronary free grafts. This article describes a technical improvement for anatomical fit and gain of length of these grafts by directing them to the right side of the heart after a passage behind the inferior vena cava.


Asunto(s)
Puente de Arteria Coronaria/métodos , Ventrículos Cardíacos/cirugía , Angiografía Coronaria , Humanos , Anastomosis Interna Mamario-Coronaria/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Venas/trasplante , Vena Cava Inferior
4.
Ann Thorac Surg ; 66(3): 959-60, 1998 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-9768971

RESUMEN

The management of superficial sternal wound infections is not well-codified. In case of large necrosis or tissue defect we use a two-stage approach, consisting of a first surgical debridement, followed a few days later by wound closure by means of two lateral advancement flaps. We have used this technique with good cosmetic results and shorter hospital stays.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Colgajos Quirúrgicos , Infección de la Herida Quirúrgica/cirugía , Desbridamiento , Humanos
5.
Chest ; 113(5): 1296-301, 1998 May.
Artículo en Inglés | MEDLINE | ID: mdl-9596309

RESUMEN

STUDY OBJECTIVES: Prospective evaluation of a selectively flexible annuloplasty ring was undertaken to assess its safety and efficacy. PATIENTS: Between December 1992 and November 1996, 190 patients with mitral regurgitation underwent mitral valve repair using an annuloplasty ring (Carpentier-Edwards Physio; Baxter-Edwards CVS Laboratories; Irvine, Calif). Ninety-four were in New York Heart Association class I or II. Etiology was degenerative in 74% of the patients. RESULTS: Four patients died early for a hospital mortality of 2.1%, and one late death occurred. Two patients with systolic anterior motion required early valve replacement. Two transient episodes of hemiparesis occurred during the first postoperative month. There were no late thromboembolic complications, no late reoperation, and no endocarditis. Mean follow up of 23+/-13 months was complete in 99% of the patients. Seventy-seven patients (40.5%) have had Doppler echocardiography > 1 year after surgery: 61 (80%) of them have no residual regurgitation, 15 have grade 1+/4+ mitral regurgitation, while 1 has grade 2+/4+ insufficiency. Left ventricular end-diastolic volume index (mL/lm2) decreased from 107.4+/-35.5 preoperatively to 74.2+/-24.4 at last control (p<0.001). CONCLUSION: The physio annuloplasty ring provided reliable and stable results at medium-term follow-up with a very low incidence of valve-related complications.


Asunto(s)
Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Prótesis e Implantes , Ecocardiografía Doppler , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Estudios Prospectivos , Implantación de Prótesis/métodos , Factores de Tiempo
6.
Ann Thorac Surg ; 66(6): 2051-5, 1998 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-9930492

RESUMEN

BACKGROUND: The purpose of this study was to determine whether, with appropriate techniques, diabetic patients could benefit from the advantages of double internal thoracic artery (ITA) coronary bypass without an increased hospital risk. METHODS: Between January 1990 and December 1996, 207 consecutive diabetic patients underwent coronary artery bypass graft operations. In 74 patients both arteries (bilateral ITA group) were used, whereas 133 patients received one ITA and vein grafts or vein grafts alone (nonbilateral group). Patients in the bilateral ITA group were younger (p<0.0001), predominantly male (p<0.0001), and were operated on more electively. The internal thoracic arteries were harvested by skeletonization without electrocautery, and strict glycemic control was pursued. RESULTS: No death was observed in the bilateral ITA group, whereas 7 patients died in the nonbilateral ITA group (p<0.05). Deep sternal wound infection was observed in 2 patients in the nonbilateral ITA group (1.5%) and in none of the bilateral ITA group (p = NS). There was no significant difference in the morbidity rate between the two groups except for greater blood losses in the bilateral ITA group. CONCLUSION: Double ITA coronary revascularization in young diabetic patients was performed without increased morbidity and mortality. The low rate of sternal wound infections may be related to ITA harvesting by a skeletonization technique, but larger studies are required to confirm these data.


Asunto(s)
Enfermedad Coronaria/cirugía , Angiopatías Diabéticas/cirugía , Anastomosis Interna Mamario-Coronaria , Complicaciones Posoperatorias/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Anastomosis Interna Mamario-Coronaria/métodos , Masculino , Persona de Mediana Edad , Morbilidad , Selección de Paciente , Estudios Retrospectivos , Factores de Riesgo
9.
J Thorac Cardiovasc Surg ; 112(2): 415-23, 1996 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-8751510

RESUMEN

Three groups of unusual forms of tracheobronchial compression caused by vascular anomalies are presented. Three patients had an encircling right aortic arch with a left-sided descending aorta and ligamentum arteriosum (group 1), two patients had airway compression caused by a pincer effect between a malposed and enlarged ascending aorta and the descending aorta (group 2), and three patients had airway compression after an arterial switch operation for transposition of the great arteries (group 3). Symptoms developed in all patients before the age of 4 months, and six of them had multiple failed attempts at extubation before the surgical intervention directed at relieving the airway compression. Fiberoptic endoscopy was used in all patients as a first-line diagnostic tool and was 100% accurate in establishing the diagnosis. The operations performed were aortic uncrossing in group 1, dissection and aortopexy of the right or left main bronchus in group 2, and dissection of the left main bronchus and lysis of adhesions in group 3. In group 1 there was one early death, resulting from aspiration, and one late death 4 years later, resulting from an unrelated cause. In this group, bronchomalacia was noted after the operation and resolved gradually in the year after the intervention. In group 2, one patient died of an aortobronchial fistula after placement of a bronchial stent. Group 3 patients had good postoperative results. Two of them are completely symptom-free and one has residual bronchomalacia and may need placement of a bronchial stent.


Asunto(s)
Aorta/anomalías , Enfermedades Bronquiales/etiología , Cardiopatías Congénitas/complicaciones , Enfermedades de la Tráquea/etiología , Aorta Torácica/anomalías , Enfermedades de la Aorta/etiología , Enfermedades Bronquiales/cirugía , Fístula Bronquial/etiología , Broncoscopía , Disección , Femenino , Tecnología de Fibra Óptica , Fístula/etiología , Humanos , Lactante , Intubación Intratraqueal , Masculino , Complicaciones Posoperatorias , Stents/efectos adversos , Tasa de Supervivencia , Adherencias Tisulares/cirugía , Enfermedades de la Tráquea/cirugía , Transposición de los Grandes Vasos/cirugía , Desconexión del Ventilador
10.
J Thorac Cardiovasc Surg ; 109(1): 164-74; discussion 174-6, 1995 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-7815793

RESUMEN

Between 1980 and 1993, 20 patients less than 1 year of age underwent operations for congenital mitral valve disease. Ten patients had congenital mitral incompetence and 10 had congenital mitral stenosis. Mean age was 6.6 +/- 3.4 months and mean weight was 5.6 +/- 1.5 kg. Atrioventricular canal defects, univentricular heart, class III/IV hypoplastic left heart syndrome, discordant atrioventricular and ventriculoarterial connections, and acquired mitral valve disease were excluded. Indications for operation were intractable heart failure or severe pulmonary hypertension, or both. Associated lesions, present in 90% of the patients, had been corrected by a previous operation in seven. In congenital mitral incompetence there was normal leaflet motion (n = 3), leaflet prolapse (n = 2), and restricted leaflet motion (n = 5). In congenital mitral stenosis anatomic abnormalities were parachute mitral valve (n = 4), typical mitral stenosis (n = 3), hammock mitral valve (n = 2), and supramitral ring (n = 1). Mitral valve repair was initially performed in 19 patients and valve replacement in one with hammock valve. Concurrent repair of associated lesions was performed in 12 patients. The operative mortality rate was zero. There were six early reoperations in five patients for mitral valve replacement (n = 4), a second repair (n = 1), and prosthetic valve thrombectomy (n = 1). One late death occurred 9 months after valve replacement. Late reoperations for mitral valve replacement (n = 2), aortic valve replacement (n = 1), mitral valve repair (n = 2), subaortic stenosis resection (n = 1), and second mitral valve replacement (n = 1) were performed in five patients. Actuarial freedom from reoperation is 58.0% +/- 11.3% (70% confidence limits 46.9% to 68.9%) at 7 years. After a mean follow-up of 67.6 +/- 42.8 months, 94% of living patients are in New York Heart Association class I. Doppler echocardiographic studies among the 13 patients with a native mitral valve show mitral incompetence of greater than moderate degree in one patient and no significant residual mitral stenosis. Overall, six patients have mitral prosthetic valves with a mean transprosthetic gradient of 6.2 +/- 3.7 mm Hg. These results show that surgical treatment for congenital mitral valve disease in the first year of life can be performed with low mortality. Valve repair is a realistic goal in about 70% of patients and possibly more with increased experience. Reoperation rate is still high and is related to complexity of mitral lesions and associated anomalies, but late functional results are encouraging.


Asunto(s)
Insuficiencia de la Válvula Mitral/congénito , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/congénito , Estenosis de la Válvula Mitral/cirugía , Estudios de Seguimiento , Prótesis Valvulares Cardíacas , Humanos , Lactante , Insuficiencia de la Válvula Mitral/fisiopatología , Estenosis de la Válvula Mitral/fisiopatología , Morbilidad , Reoperación , Estudios Retrospectivos
11.
Ann Thorac Surg ; 58(4): 1096-102, 1994 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-7944758

RESUMEN

The outcome of Fontan-type procedures is dependent on several risk factors, among which pulmonary vascular resistances (PVRs) are an important component. Preoperative calculation of PVR entails several potential sources of error, particularly in patients with pulmonary atresia or multiple sources of pulmonary blood flow. In an attempt to develop a reliable test that accurately assesses the hemodynamic patterns of the pulmonary vascular bed before a Fontan procedure, a simulation of Fontan-type circulation was achieved in 13 patients by a partial cardiopulmonary bypass between the main pulmonary artery and both venae cavae (cavopulmonary bypass). During cavopulmonary bypass, pressures and resistances were recorded. Immediately after cavopulmonary bypass, the circulation was converted to standard cardiopulmonary bypass and the cavopulmonary connection was carried out. Preoperative pulmonary vascular resistance indexes were assessed roughly by the arteriovenous oxygen difference in systemic and pulmonary beds. There was no correlation between preoperative and perioperative calculations of pulmonary vascular resistance indexes (r = 0.24; p = not significant). Hemodynamic data available for all patients then were correlated to the early postoperative outcome assessed by a subjective four-point scale. A positive, significant correlation was found with intraoperative PVR (r = 0.90; p < 0.001), indexed PVR (r = 0.90; p < 0.001), and the pulmonary to systemic vascular resistance ratio (r = 0.98; p < 0.0001). Two of 13 patients had a 4-mm fenestration in the atrial baffle. No mortality or morbidity was related to the procedure. The absolute values of PVR and pulmonary vascular resistance indexes were strikingly higher than generally admitted for this type of procedure.(ABSTRACT TRUNCATED AT 250 WORDS)


Asunto(s)
Procedimiento de Fontan/métodos , Circulación Pulmonar/fisiología , Adolescente , Cateterismo Cardíaco , Puente Cardiopulmonar , Niño , Preescolar , Humanos , Lactante , Resistencia Vascular
12.
Circulation ; 88(5 Pt 2): II177-82, 1993 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-8222151

RESUMEN

BACKGROUND: Subaortic obstruction is one of the risk factors for anatomic repair of double outlet right ventricles (DORV). A comprehensive approach to such lesions has been developed in our institution since 1981. This retrospective work analyzes the results of this approach. METHODS AND RESULTS: Between January 1981 and September 1992, 30 patients aged 15 days to 15 years (mean, 44.8 months) underwent repair of a DORV associated with subaortic obstruction. Eighteen patients had a palliative procedure before complete repair. The ventricular septal defect (VSD) was subaortic in 15 patients, doubly committed in 1, noncommitted in 9, and subpulmonary in 5. The subaortic obstruction was a result of restrictive VSD in 29 patients and of double straddling of mitral and tricuspid valves once. The preoperative peak systolic pressure gradient between the left ventricle and the aorta (LV-Ao) was 68.7 +/- 23 mm Hg. Reconstruction of the left ventricular outflow tract comprised a ventral enlargement of the VSD in subaortic, doubly committed, and those subpulmonary VSDs scheduled for an arterial switch operation or a conal resection in noncommitted and other subpulmonary forms. Reconstruction of the right ventricular outflow tract included primary closure of the right ventricle in 12 patients, an infundibular patch in 9, a transannular patch in 4, and insertion of a right ventricular pulmonary valved conduit in 5. There were two early (6.6%) and two late (7.1%) deaths. Three patients required reoperation. A mean follow-up of 60.5 +/- 46.8 months was achieved in all the survivors. They were all in New York Heart Association class I or II, in sinus rhythm. At last follow-up, the mean LV-Ao gradient was 7.5 +/- 6.2 mm Hg, and LV function indices were within normal ranges. Actuarial survival and freedom from reoperation rates at 8 years were 86.6% and 87.0%, respectively. CONCLUSIONS: Surgical relief of subaortic obstruction in DORV has to be adapted to VSD location and spatial arrangement of atrioventricular valves and great vessels.


Asunto(s)
Estenosis Aórtica Subvalvular/cirugía , Ventrículo Derecho con Doble Salida/complicaciones , Defectos del Tabique Interventricular/cirugía , Estenosis Aórtica Subvalvular/etiología , Preescolar , Ventrículo Derecho con Doble Salida/mortalidad , Ventrículo Derecho con Doble Salida/cirugía , Femenino , Estudios de Seguimiento , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/mortalidad , Humanos , Masculino , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Factores de Tiempo
13.
Ann Thorac Surg ; 55(4): 990-2, 1993 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-8466357

RESUMEN

Two cases of neonatal aortic arch thrombosis are reported. One patient, who had ascending aortic thrombosis, died preoperatively. The other had reoperation and is alive and well at 6 months' follow-up. No obvious cause was found.


Asunto(s)
Aorta Torácica , Trombosis/congénito , Adulto , Aorta Torácica/cirugía , Femenino , Humanos , Recién Nacido , Masculino , Reoperación , Trombosis/complicaciones , Trombosis/patología , Trombosis/cirugía
14.
Ann Thorac Surg ; 54(2): 323-6, 1992 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-1637228

RESUMEN

Reports concerning unruptured, isolated aneurysms of one sinus of Valsalva are rare. These aneurysms usually protrude inside the heart and are very rarely extracardiac. We report 4 cases of isolated, unruptured extracardiac aneurysms of the noncoronary sinus of Valsalva. Clinical symptoms were nonspecific. Operation was performed by patch reconstruction of the dilated aortic sinus without replacement of the ascending aorta. Microscopic examination of the diseased aortic wall revealed absence of medial elastic fibers. Late follow-up in all 4 cases revealed a normal ascending aorta with no dilatation of the aortic root and no aortic regurgitation.


Asunto(s)
Aneurisma de la Aorta , Seno Aórtico , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/patología , Aneurisma de la Aorta/cirugía , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad
15.
Ann Thorac Surg ; 54(1): 89-92, 1992 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-1610260

RESUMEN

Between 1987 and 1990, 12 patients were operated on for endomyocardial fibrosis at our institution. Nine were treated by endocardectomy and mitral valve repair and constitute the material of this study. Ages ranged from 9 to 58 years (mean age, 32.5 years). Biventricular involvement was present in 3 cases, and 6 patients had predominantly left ventricular endomyocardial fibrosis. Six patients were in New York Heart Association class III/IV. Six patients had severe mitral insufficiency (3 to 4/4) and 3 patients had moderate mitral insufficiency (2/4). The operation consisted of left ventricular endocardectomy with complete detachment and mobilization of the posterior leaflet of the mitral valve in all cases. An autologous pericardial patch was used to reconstruct posterior leaflet continuity in 4 patients. In 7 patients a prosthetic mitral ring was used. In 3 patients right ventricular endocardectomy and tricuspid valve repair were also performed. All patients survived and none required early reoperation. Follow-up was complete and ranged from 9 to 38 months. No late deaths occurred, and 1 patient required mitral valve replacement for recurrent mitral regurgitation. Doppler echocardiographic studies were performed in 7 patients and revealed no or mild mitral insufficiency. In conclusion, mitral valve repair is safe and offers good early and late results in patients with endomyocardial fibrosis.


Asunto(s)
Fibrosis Endomiocárdica/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad
16.
Ann Thorac Surg ; 53(2): 356-61, 1992 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-1731689

RESUMEN

Cardiac pheochromocytomas are rare. Thirty cases have been reported in the literature. We report the cases of 2 more patients in whom the diagnosis was established using coronary angiography and who underwent surgical resection using cardiopulmonary bypass. We also review the literature on the subject.


Asunto(s)
Neoplasias Cardíacas/diagnóstico , Feocromocitoma/diagnóstico , Adulto , Catecolaminas/sangre , Catecolaminas/orina , Femenino , Neoplasias Cardíacas/sangre , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/orina , Humanos , Hipertensión/etiología , Masculino , Feocromocitoma/sangre , Feocromocitoma/complicaciones , Feocromocitoma/cirugía , Feocromocitoma/orina
17.
J Vasc Surg ; 14(2): 215-9, 1991 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-1861333

RESUMEN

Mycotic aneurysms of the extracranial carotid arteries are rare. We report a new case with a mycotic aneurysm of the carotid bifurcation associated with acute bacterial endocarditis of the aortic valve. A concomitant treatment of both lesions was performed. Twenty-six cases of mycotic aneurysms of the extracranial carotid arteries have been reported in the literature. We present a review of all these cases.


Asunto(s)
Aneurisma Infectado/diagnóstico , Enfermedades de las Arterias Carótidas/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Enfermedad Aguda , Aneurisma Infectado/cirugía , Válvula Aórtica/cirugía , Enfermedades de las Arterias Carótidas/cirugía , Arteria Carótida Externa/cirugía , Terapia Combinada , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/cirugía , Humanos , Masculino , Persona de Mediana Edad , Infecciones Estreptocócicas/cirugía , Vancomicina/uso terapéutico
18.
J Vasc Surg ; 14(1): 117-20, 1991 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-2061952

RESUMEN

Thirty-nine patients with penetrating carotid injuries were treated between 1975 and 1987. All were war victims. On admission 27 (69%) had no neurologic deficit (group I), 8 (20.5%) had a mild neurologic deficit (group II), and 4 (10.5%) had a severe deficit (group III). Repair was undertaken in 38 of 39 (97.5%) patients, and carotid ligation was performed in 1 case (2.5%). Associated injuries were found in 25 (65%) patients. All patients survived. At the time of discharge all group I and II patients had a normal neurologic examination. One patient in group III recovered completely, whereas two had significant improvement. One patient remained unchanged. We conclude that repair should be attempted in all patients with carotid injuries who are seen early (less than 120 minutes) after the accident.


Asunto(s)
Traumatismos de las Arterias Carótidas , Guerra , Heridas Penetrantes/cirugía , Adolescente , Adulto , Arterias Carótidas/cirugía , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Heridas por Arma de Fuego/cirugía
19.
J Chir (Paris) ; 127(8-9): 404-7, 1990.
Artículo en Francés | MEDLINE | ID: mdl-2229214

RESUMEN

One hundred arteriographies were performed in emergency in 87 patients with penetrating trauma of the lower limbs caused by high- or medium-velocity projectiles (bullet or shell fragment). Thirteen patients had bilateral wounds. In 79 cases, the arteriogram was abnormal and led to surgical exploration. In 76 cases, an arterial lesion was found and treated (positive predictive value = 76/79 = 96%). In three cases, no arterial lesion was detected (3 false-positive findings). Among the 21 patients with normal arteriograms, 10 had surgical exploration because of clinical suspicion. An arterial lesion was found in 2 cases (2 false-negative findings). In the other 11 cases, the clinical and Doppler sonographic observations were normal (negative predictive value = 19/21 = 90%). The sensitivity rate was 97%, specificity 86% and accuracy 95%. In 8 cases, arteriography led to modifying the surgical procedure. These results show that preoperative arteriography, performed as an emergent examination in hemodynamically stable patients, allows avoiding surgery in some cases, and modifying the procedure in others.


Asunto(s)
Traumatismos de la Pierna/diagnóstico por imagen , Heridas por Arma de Fuego/diagnóstico por imagen , Adolescente , Adulto , Angiografía , Urgencias Médicas , Femenino , Humanos , Traumatismos de la Pierna/cirugía , Traumatismos de la Pierna/terapia , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico por imagen , Estudios Retrospectivos , Heridas por Arma de Fuego/cirugía , Heridas por Arma de Fuego/terapia
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA