RESUMO
A 62-year-old man was admitted to the hospital due to sepsis secondary to a hemodialysis catheter-related infection that, upon diagnostic evaluation, demonstrated to be caused by P. aeruginosa and was treated with meropenem. Eradication of the infectious episode was confirmed by blood workup, including cultures. One month after the initial episode, the patient was readmitted due to a symptomatic penetrating aortic ulcer, which was classified as a cardiovascular emergency. The patient underwent an aortic stent-graft placement. Four weeks later, he presented to the emergency department with a 2-hour onset of thoracic pain and massive hematemesis. The esophagus and aortic segment with aortic stent graft were resected en bloc after an aortoesophageal fistula was diagnosed.
Assuntos
Aneurisma da Aorta Torácica , Doenças da Aorta , Implante de Prótese Vascular , Fístula Esofágica , Fístula Vascular , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/efeitos adversos , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/cirurgiaRESUMO
Background Infectious lung cavities are a common entity for the respiratory physician. Sometimes these lesions require surgical treatment, but surgery is challenging, and complications are common. Methods Patients with infectious lung cavities amenable to surgical treatment were included in a case-control study. The control group included patients with no complications. The cases group comprised patients with any of the following complications up to 90 days after surgery: death, persistence of hemoptysis, empyema, operative blood loss > 500 mL, vascular lesion requiring repair, massive transfusion (>5 units of packed red blood cells per 48 h) or reoperation for bleeding, postoperative mechanical ventilation, intensive care unit stay > 48 h, prolonged air leak, and persistent atelectasis. The potential risk factors for complications analyzed were demographic data, exposure to contaminants, comorbidities, preoperative embolization, surgical indication, spirometry results, and sputum test positive for Mycobacterium tuberculosis. Results Forty-five patients were included in the study and divided into 24 cases and 21 controls. We found a significant difference in the time to removal of chest tubes in favor of the noncomplicated cases (6.45 vs. 4.05 days, p = 0.030), and persistent active infection at the time of surgery tended to be a risk factor for complications (odds ratio = 6.6, 95% confidence interval: 0.7-60, p = 0.061). Conclusion The presence of persistent active infection at the time of surgery could be a risk factor for complications in resection surgery for infectious lung cavities.
Assuntos
Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Infecções Respiratórias/cirurgia , Perda Sanguínea Cirúrgica , Distribuição de Qui-Quadrado , Empiema Pleural/etiologia , Transfusão de Eritrócitos/efeitos adversos , Feminino , Hemoptise/etiologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Hemorragia Pós-Operatória/etiologia , Atelectasia Pulmonar/etiologia , Respiração Artificial/efeitos adversos , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Prolonged air leak after pleural decortication is one of the most frequent complications. OBJECTIVE: The aim of this study is to compare the effects of prolonged air leak between the digital chest drainage (DCD) system and the classic drainage system in patients with empyema class IIB or III (American Thoracic Society classification) in pleural decortication patients. MATERIAL AND METHODS: A total of 37 patients were enrolled in a prospective randomized control trial over one year, consisting of 2blinded groups, comparing prolonged air leak as a main outcome, the number of days until removal of chest drain, length of hospital stay and complications as secondary outcomes. RESULTS: The percentage of prolonged air leak was 11% in the DCD group and 5% in the classic group (P=0.581); the mean number of days of air leak was 2.5±1.8 and 2.4±2.2, respectively (P=0.966). The mean number of days until chest tube removal was 4.5±1.8 and 5.1±2.5 (P=0.41), the length of hospital stay was 7.8±3.7 and 8.9±4.0 (P=0.441) and the complication percentages were 4 (22%) and 7 (36%), respectively (P=0.227). DISCUSSION: In this study, no significant difference was observed when the DCD was compared with the classic system. This was the first randomized clinical trial for this indication; thus, future complementing studies are warranted.
Assuntos
Drenagem/efeitos adversos , Empiema Pleural/cirurgia , Complicações Intraoperatórias/prevenção & controle , Pleura/lesões , Pneumotórax/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Tubos Torácicos , Drenagem/instrumentação , Drenagem/métodos , Feminino , Hemotórax/etiologia , Humanos , Complicações Intraoperatórias/etiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pleura/cirurgia , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Estudos ProspectivosRESUMO
Tracheobronchial stenosis is common in the thoracic surgery service, and iatrogenic injury of the airway after manipulation is not infrequent. When a digital thoracic drainage system came onto the market, many advantages were evident. A 24-year-old woman with critical right main bronchial stenosis underwent airway dilation that was complicated by a tear with a massive air leak, resulting in a total right pneumothorax. We employed a pleural drain connected to a digital thoracic drainage system. The drain was removed 2 days after successful resolution of the air leak.
Assuntos
Obstrução das Vias Respiratórias/terapia , Brônquios/lesões , Broncopatias/terapia , Dilatação/efeitos adversos , Drenagem/instrumentação , Pneumotórax/terapia , Obstrução das Vias Respiratórias/diagnóstico , Broncopatias/diagnóstico , Drenagem/métodos , Desenho de Equipamento , Feminino , Humanos , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Resultado do Tratamento , Adulto JovemRESUMO
Myofibroblastic inflammatory tumors (MIT) of location in carina represent a diagnostic, classification, and treatment challenge, due to the scarcity of reports. The actual evidence supports the theory that MITs are lower-grade sarcomas. Here we present the case of a 23-year-old man with MIT in carina who was treated with tumor resection by carinectomy and tracheobronchial reconstruction. In spite of the few reports of these tumors in that location, the surgical treatment looking for complete resection is the gold standard of treatment.