RESUMO
OBJECTIVES: To evaluate the early and late results of surgical treatment of patients with bronchiectasis, comparing the Video-Assisted Thoracic Surgery (VATS) vs. the open thoracotomy (OT). METHODS: Observational retrospective study of patients who underwent surgery for bronchiectasis. Patients were divided into two groups according to surgical access OT/VATS. Variables collected included gender, age, preoperative symptoms, etiology, segments involved, FVC and FEV1, type of surgical resection, complications, mortality, and length of hospital stay. Late surgical results were classified as excellent, complete remission of symptoms; good, significative improvement; and poor, little/no improvement. RESULTS: 108 surgical resections (103 patients). OT group 54 patients (52.4%) vs. VATS 49 (47.6%). A high percentage of complications was observed, but no difference between the OT (29.6%) and VATS (24.5%) groups was found. Post-operative hospital stay was shorter in the VATS group (5.4 days) vs. the OT group (8.7 days (p=0.029). 75% of the patients had a late follow-up; the results were considered excellent in 71.4%, good in 26%, and poor in 2.6%. Regarding bronchiectasis distribution, an excellent percentage was obtained at 82.1% in patients with localized bronchiectasis and 47.5% with non-localized bronchiectasis, p=0.003. CONCLUSIONS: VATS leads to similar results regarding morbidity, compared to OT. However, VATS was related to shorter hospital stays, reflecting the early recovery. Late results were excellent in most patients, being better in patients with localized bronchiectasis. VATS should be considered a preferable approach for bronchiectasis lung resection whenever possible.
Assuntos
Bronquiectasia , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Humanos , Bronquiectasia/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Resultado do Tratamento , Pneumonectomia/métodos , Pneumonectomia/efeitos adversos , Toracotomia/métodos , Fatores de Tempo , Idoso , AdultoRESUMO
ABSTRACT Objectives: To evaluate the early and late results of surgical treatment of patients with bronchiectasis, comparing the Video-Assisted Thoracic Surgery (VATS) vs. the open thoracotomy (OT). Methods: Observational retrospective study of patients who underwent surgery for bronchiectasis. Patients were divided into two groups according to surgical access OT/VATS. Variables collected included gender, age, preoperative symptoms, etiology, segments involved, FVC and FEV1, type of surgical resection, complications, mortality, and length of hospital stay. Late surgical results were classified as excellent, complete remission of symptoms; good, significative improvement; and poor, little/no improvement. Results: 108 surgical resections (103 patients). OT group 54 patients (52.4%) vs. VATS 49 (47.6%). A high percentage of complications was observed, but no difference between the OT (29.6%) and VATS (24.5%) groups was found. Post-operative hospital stay was shorter in the VATS group (5.4 days) vs. the OT group (8.7 days (p=0.029). 75% of the patients had a late follow-up; the results were considered excellent in 71.4%, good in 26%, and poor in 2.6%. Regarding bronchiectasis distribution, an excellent percentage was obtained at 82.1% in patients with localized bronchiectasis and 47.5% with non-localized bronchiectasis, p=0.003. Conclusions: VATS leads to similar results regarding morbidity, compared to OT. However, VATS was related to shorter hospital stays, reflecting the early recovery. Late results were excellent in most patients, being better in patients with localized bronchiectasis. VATS should be considered a preferable approach for bronchiectasis lung resection whenever possible.
RESUMO Objetivos: Avaliar os resultados precoces e tardios do tratamento cirúrgico de pacientes com bronquiectasias, comparando a Cirurgia Torácica Videoassistida (VATS) versus a toracotomia (TO). Métodos: Estudo retrospectivo observacional de pacientes submetidos à cirurgia de bronquiectasias. Os pacientes foram divididos em dois grupos de acordo com o acesso cirúrgico TO/VATS. As variáveis coletadas incluíram sexo, idade, sintomas pré-operatórios, etiologia, segmentos envolvidos, CVF e VEF1, tipo de ressecção cirúrgica, complicações, mortalidade e tempo de internação. Os resultados cirúrgicos tardios foram classificados como excelentes, remissão completa dos sintomas; bom, melhora significativa; e pobre, pouca/nenhuma melhoria. Resultados: 108 ressecções cirúrgicas (103 pacientes). Grupo TO 54 pacientes (52,4%) vs. VATS 49 (47,6%). Observou-se alto percentual de complicações, mas não foi encontrada diferença entre os grupos TO (29,6%) e VATS (24,5%). O tempo de internação pós-operatório foi menor no grupo VATS (5,4 dias) versus o grupo TO (8,7 dias) (p=0,029). 75% dos pacientes tiveram seguimento tardio; os resultados foram considerados excelentes em 71,4%, bom em 26% e ruim em 2,6%. Quanto à distribuição das bronquiectasias, o percentual excelente foi de 82,1% em pacientes com bronquiectasias localizadas e 47,5% com bronquiectasias não localizadas, p=0,003. Conclusões: VATS mostrou resultados semelhantes em relação à morbidade, comparado ao TO. No entanto, a VATS foi relacionada a internações hospitalares mais curtas, refletindo a recuperação precoce. Os resultados tardios foram excelentes na maioria dos pacientes, sendo melhores em pacientes com bronquiectasias localizadas. A VATS deve ser considerada uma abordagem preferível para a ressecção pulmonar de bronquiectasias sempre que possível.
RESUMO
BACKGROUND: Stroke is the main cause of oropharyngeal neurogenic dysphagia. Electrostimulation has been used as a therapeutic tool in these cases. However, there are few studies that prove its effectiveness. We evaluated the effect of functional electrostimulation as a complement to conventional speech therapy in patients with dysphagia after a stroke in a stroke unit. METHODS: We performed a clinical, randomized, and controlled trial divided into intervention group (IG) (n = 16) and control group (CG) (n = 17). All patients were treated with conventional speech therapy, and the IG also was submitted to the functional electrotherapy. Primary outcomes were Functional Oral Ingestion Scale (FOIS) and Swallowing videoendoscopy (FEES). The degree of dysphagia was scored in functional, mild, moderate and severe dysphagia according to FEES procedure. Dysphagia Risk Evaluation Protocol (DREP) was considered a secondary outcome. RESULTS: There was a significant difference regarding FOIS scores after 5 days of intervention in groups. Both groups also showed a tendency to improve dysphagia levels measured by FEES, although not statistically significant. Improvements on oral feeding was seen in both groups. No significant differences between groups before and after the intervention were detected by DREP scores. Electrical stimulation did not show additional benefits beyond conventional therapy when comparing outcomes between groups. CONCLUSION: Conventional speech therapy improved oral ingestion even regardless the use of electrostimulation in a stroke unit. TRIAL REGISTRATION: This research was registered in ClinicalTrials.gov (Identifier: NCT03649295 ) in 28/08/2018 and in the Brazilian Registry of Clinical Trials (ReBEC) (Register Number: RBR-56QK5J), approval date: 18/12/2018. HGF Ethics Committee Approval Number: N. 2.388.931.
Assuntos
Transtornos de Deglutição , Terapia por Estimulação Elétrica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Deglutição , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Estimulação Elétrica/efeitos adversos , Terapia por Estimulação Elétrica/métodos , Humanos , Fonoterapia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Dysphagia is characterized by difficulty in the swallowing pattern at any stage of this neuromuscular process. It is a frequent symptom after stroke. OBJECTIVE: This study aimed to investigate the most commonly used phonoaudiological interventions as therapy for the treatment of swallowing disorders in patients with dysphagia after stroke. METHODS: We performed a review of studies indexed in MEDLINE-PubMed, LILACS, Cochrane, and Clinical trials.gov focusing on speech-language interventions for adult dysphagic patients after stroke between January 2008 and January 2021. RESULTS: Thirty-six articles of clinical trials were selected. Eleven different types of therapies have been studied. Studies on the efficacy of therapeutic interventions for the rehabilitation of adult patients with dysphagia after stroke are still scarce. Most techniques are combined with conventional therapy, so the effectiveness of the other techniques alone cannot be assessed. CONCLUSIONS: Therapeutic interventions should be selected in accordance with the possibilities and limitations of the patients, and especially with the findings of the clinical evaluation and with its objective.
Assuntos
Transtornos de Deglutição , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adulto , Deglutição , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/reabilitação , Humanos , Acidente Vascular Cerebral/complicaçõesRESUMO
ABSTRACT Background: Dysphagia is characterized by difficulty in the swallowing pattern at any stage of this neuromuscular process. It is a frequent symptom after stroke. Objective: This study aimed to investigate the most commonly used phonoaudiological interventions as therapy for the treatment of swallowing disorders in patients with dysphagia after stroke. Methods: We performed a review of studies indexed in MEDLINE-PubMed, LILACS, Cochrane, and Clinical trials.gov focusing on speech-language interventions for adult dysphagic patients after stroke between January 2008 and January 2021. Results: Thirty-six articles of clinical trials were selected. Eleven different types of therapies have been studied. Studies on the efficacy of therapeutic interventions for the rehabilitation of adult patients with dysphagia after stroke are still scarce. Most techniques are combined with conventional therapy, so the effectiveness of the other techniques alone cannot be assessed. Conclusions: Therapeutic interventions should be selected in accordance with the possibilities and limitations of the patients, and especially with the findings of the clinical evaluation and with its objective.
RESUMO Antecedentes: A disfagia é caracterizada como uma dificuldade no padrão de deglutição em qualquer fase desse processo neuromuscular. É um sintoma frequente após o Acidente Vascular Cerebral. Objetivos: O objetivo deste estudo foi investigar as intervenções fonoaudiológicas mais utilizadas como terapia para o tratamento dos distúrbios da deglutição em pacientes com disfagia pós AVC. Métodos: Realizamos uma revisão dos estudos indexados no MEDLINE-PubMed, LILACS, Cochrane e Clinical trials.gov com foco nas intervenções fonoaudiológicas em pacientes adultos e disfágicos após AVC entre janeiro de 2008 e janeiro de 2021. Resultados: Foram selecionados trinta e seis artigos de ensaios clínicos e estudados onze tipos de terapia. Os estudos sobre a eficácia de intervenções terapêuticas para a reabilitação destes pacientes adultos ainda são restritos. A maioria das técnicas é aplicada em combinação com a terapia convencional, tornando inconclusiva a medição da eficácia de outras técnicas isoladamente. Conclusões: As intervenções terapêuticas devem ser escolhidas de acordo com as possibilidades e limitações dos pacientes e, principalmente, com os achados da avaliação clínica e seu objetivo.