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PURPOSE: To evaluate factors related to the length of hospital stay and costs in patients undergoing local multimodal anesthetic solution compared to neuraxial block, both in association with general anesthesia. METHODS: This is a retrospective cohort study of 77 consecutive patients submitted to open radical prostatectomies: 42 under general anesthesia plus neuraxial block, and 35 under enhanced recovery multimodal general anesthesia associated with preemptive target anesthetic solution (3 phases-P.T.A.S). Mann-Whitney, Chi-square, and Spearman correlation were applied with a 5% significance level. RESULTS: There were no statistically significant differences between the two groups. The cost was positively and significantly related to the pathological report (PR), anesthetic time, use of crystalloid, and total drain volume. Length of hospital stay was positively and significantly related to the use of crystalloids and total drain volume, with a strong correlation with the latter. CONCLUSION: There was no statistically significant difference between the studied groups; however, there was a tendency to reduce the length of stay in the multimodal anesthetic solution group that may be better evidenced in studies with greater sampling power.
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BACKGROUND: In Low-Middle Income Countries (LMICs), resource optimization and infrastructure availability are recurrently in debate. In order to assist the development and implementation of guidelines, LMICs often exemplify from High-Income Countries protocols. At the final, it will be: content adaption is often needed. In this study, we demonstrated the preliminary analysis of the Brazilian experience by adapting the ERAS® Protocol for thoracic surgery patients (PROSM). METHODS: Patients' data were extracted from the surgical group database that operated in the city of Sao Paulo. Patients' data were organized for analysis after the institution's ethics committee gave their approval. Patients' variables were analyzed and compared to a control group. Subgroup analysis included patients without ICU Admission. RESULTS: PROSM patients had reduced ICU length of stay (LOS) (Mean of 0.3±0.58 days, 1.2±1.65 days, P=0.001), Hospital LOS (Mean of 1.6±1.32 days, 3.9±3.25 days, P=0.001) and Chest Drain duration (Median 1.0±1.00 days, 3.0±3.00 days, P=0.001). Analyses of patients that were not admitted to the ICU demonstrated reduced Hospital LOS and Chest drain duration. Cost analysis, such as procedure, daily, and post-surgical costs were also significantly lower towards PROSM group. CONCLUSIONS: This study revealed important aspects for improvement of the delivered care quality and opportunity for expenditure management. We expect to assist more countries to improve knowledge under the implementation of enhanced protocols.
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Ki-67 has shown promise as a prognostic factor in pulmonary carcinoids. In this study, we sought to validate the importance of Ki-67 and study the relationships between Ki-67 and other stromal biomarkers of vascular density. We examined Ki-67, CD34, and D2-40 in tumor tissues from 128 patients with surgically excised typical carcinoid of the lung. We used immunohistochemistry and morphometry to evaluate the amount of tumor staining for cellular proliferation (Ki-67), microvascular density (CD34-MVD), and D2-40 lymphovascular density. The main outcome was overall survival, considered as life expectancy until death from metastasis. Specimens from patients with central tumors showed high CD34-MVD (P = .01), which was also significantly associated with a compromised surgical margin, lymph node metastasis, and clinical stage Ib. Equally significant was high D2-40 lymphovascular density in central specimens with a compromised surgical margin and lymph node metastasis. A high Ki-67 proliferation rate was significantly associated with tumors from patients with clinical stage IIb, IIIa, and IV disease. Multivariate Cox model analysis demonstrated that tumor location and stage, surgical margin, tumor size, and N stage were significantly related to survival time (P < .05). Quantitative staining of the tumor for Ki-67 and CD34-MVD served as prognostic factors (P < .05), which were more relevant than the surgical and pathological stage. Ki-67 greater than 5% and CD34-MVD greater than 7% staining comprise a subset of patients with higher death hazard; this outcome may harbor evidence for further prospective studies of target therapy after surgical resection.
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Anticorpos Monoclonais Murinos/imunologia , Antígenos CD34/análise , Capilares/química , Tumor Carcinoide/química , Proliferação de Células , Imunoquímica/métodos , Antígeno Ki-67/análise , Neoplasias Pulmonares/química , Linfangiogênese , Vasos Linfáticos/química , Neovascularização Patológica , Adolescente , Adulto , Idoso , Capilares/patologia , Tumor Carcinoide/mortalidade , Tumor Carcinoide/secundário , Tumor Carcinoide/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Metástase Linfática , Vasos Linfáticos/patologia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pneumonectomia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Carga Tumoral , Adulto JovemRESUMO
AIMS: Some authors have hypothesized that left ventricular chamber dilatation in ischaemic and idiopathic cardiomyopathies results in spherical transformation. Aiming to characterize how this transformation occurs, a study was performed by comparing normal and dilated specimens regarding sphericity and proportionality in left heart chambers. It is important to provide data for the development of therapeutic strategies in these diseases. METHODS AND RESULTS: An anatomical study was performed by comparing normal (n = 10), ischaemic (n = 15), and idiopathic (n = 18) dilated human cardiomyopathic specimens regarding left ventricular chambers and their segmental proportionality to normal hearts. It was performed by capturing and processing images with proper software in three different levels of left ventricular chamber (basal, equatorial, and apical). These obtained data were analysed based on sphericity and proportionality by two dedicated indexes. Spherical shape: Calculated segmental indexes showed that dilated specimens were not spherical because they were smaller than as expected for a spherical shape (all values were <70% of a perfect sphere). Proportionality: There was no difference between basal index perimeters among groups, but apical index was lower in dilated specimens than in normal hearts, and so dilatation was not proportional to normal hearts. CONCLUSIONS: Left ventricular chambers of anatomical specimens with dilated cardiomyopathies did not display a spherical shape and were not proportional to normal hearts.
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Cardiomiopatias/diagnóstico , Ventrículos do Coração/anatomia & histologia , Modelos Anatômicos , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular , Cadáver , Cardiomiopatias/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , HumanosRESUMO
PURPOSE: The aim of this study was to compare the functional exercise capacity and the lung function among patients undergoing early rehabilitation with those submitted to the conventional care after pectus excavatum repair using the Nuss procedure. METHOD: Patients were randomly allocated to the early rehabilitation group (ERG) who started rehabilitation after surgery and the group of the conventional care (CG) received routine care of the institution. They were evaluated before surgery (preoperative) and in hospital discharge day (postoperative). RESULTS: Forty patients were evaluated, twenty in each group. All patients presented a significant reduction in FVC, FEV1, and PEF in the postoperative period, there was no statistically significant difference between groups. There was significant different in postoperative functional exercise capacity between the ERG and CG (506.26 ± 66.54 vs 431.11 ± 75.61, p = 0.02) and the difference between distance walked in the preoperative and postoperative period was lower in the ERC than in the CG (76.57 ± 49.41 vs 166.82 ± 70.13, p < 0.001). CONCLUSION: Patients undergoing the early rehabilitation after the Nuss procedure presented a better postoperative functional exercise capacity in hospital discharge day compared with patients in the conventional group, with no difference in lung function between groups.
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Terapia por Exercício/métodos , Tolerância ao Exercício/fisiologia , Tórax em Funil/cirurgia , Fenômenos Fisiológicos Respiratórios , Toracoplastia/reabilitação , Adolescente , Feminino , Tórax em Funil/reabilitação , Humanos , Masculino , Período Pós-Operatório , Resultado do TratamentoRESUMO
"The First Minimally Invasive Thoracic Surgery Uniportal Course" in Mexico was held from July 13th to 15th in Mexico City, at the National Institute of Respiratory Diseases (INER). Thoracic surgeons from around Mexico assisted the course. The special guests were the Spanish doctor Diego González-Rivas and the Brasilian doctor Joao Carlos das Neves-Pereira. The course included live surgery and wet lab. Demonstration of the uniportal video-assisted thoracic surgery (VATS) technique was done. The course was a success and Mexican thoracic surgeons were ready to adopt this technique.
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O amplo espectro de ação dos endectocidas e a praticidade de aplicação das suas formulações pour-on são fatores que têm estimulado uma maior frequência de utilização destes produtos na criação de bovinos. Neste estudo, avaliou-se a eficácia anti-helmíntica da ivermectina, administrada via pour-on, 500mcgkg-1, contra nematódeos de bovinos provenientes de diferentes rebanhos. Foram adquiridos 12 bezerros de cada um dos quatro rebanhos selecionados. Todos os 48 bezerros utilizados apresentavam médias de ovos por grama de fezes (OPG) maiores que 500, considerando-se três contagens consecutivas. Na sequencia, os animais de cada rebanho foram divididos em dois grupos de seis bovinos cada, sendo um tratado com ivermectina 500mcgkg-1 via pour-on e outro mantido como controle. Quatorze dias depois do tratamento, os bovinos foram submetidos à eutanásia para contagem de endoparasitas. A ivermectina demonstrou resultados nulos de eficácia contra H. placei nos quatro rebanhos. Contra C. punctata, tal formulação teve eficácia nula nos rebanhos provenientes de Jaboticabal,SP, e de Formiga,MG, e eficácias de 75,8% e 58,4% nos rebanhos provenientes de São José do Rio Pardo,SP, e de São Sebastião do Paraíso,MG, respectivamente. Valores de eficácia de 94,2% (Jaboticabal), 0,0% (São José do Rio Pardo), 94,2% (Formiga) e 39,2% (São Sebastião do Paraíso) foram detectados contra O. radiatum. Com base nos resultados encontrados, pode-se concluir que as quatro populações de Haemonchus placei e de Cooperia punctata avaliadas foram resistentes à ivermectina, administrada via pour-on, 500mcgkg-1. Foram observadas cepas de Oesophagostomum radiatum resistentes à ivermectina em dois dos quatro rebanhos testados.
The broad spectrum of endectocides and the easy use mode of their pour-on formulations are factors that have stimulated a higher frequency of use these drugs in cattle. In this study was evaluated the efficacy of ivermectin pour-on using the dose of 500mcgkg-1, against nematodes in naturally infected cattle from different herds. Twelve calves were brought from each of the four farms selected. All the 48 calves used showed mean of eggs per gram of feces (EPG) greater than 500 considering three consecutive counts. Subsequently, animals from each herd were divided into two groups of six animals each, one treated pour-on with ivermectin 500mcgkg-1 and other kept as untreated control. Calves were euthanized 14 days after treatment for counting the endoparasites. Ivermectin showed null effect against H. placei in all the herds evaluated. The drug was also ineffective against C. punctata in the herds from Jaboticabal,SP and Formiga,MG, and reached efficacy of 75.8% and 58.4% in herds from São José do Rio Pardo,SP and São Sebastião do Paraíso,MG, respectively. Efficacies of 94.2% (Jaboticabal), 0.0% (São José do Rio Pardo), 94.2% (Formiga) and 39.2% (São Sebastião do Paraíso) were detectedagainst O. radiatum. Based on these results obtained on the present study, the four populations of Haemonchus placei and Cooperia punctata evaluated were resistant to ivermectin pour-on using a dose of 500mcgkg-1. Ivermectin-resistant strains of Oesophagostomum radiatum were found in two of the four herds evaluated.
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O amplo espectro de ação dos endectocidas e a praticidade de aplicação das suas formulações pour-on são fatores que têm estimulado uma maior frequência de utilização destes produtos na criação de bovinos. Neste estudo, avaliou-se a eficácia anti-helmíntica da ivermectina, administrada via pour-on, 500mcgkg-1, contra nematódeos de bovinos provenientes de diferentes rebanhos. Foram adquiridos 12 bezerros de cada um dos quatro rebanhos selecionados. Todos os 48 bezerros utilizados apresentavam médias de ovos por grama de fezes (OPG) maiores que 500, considerando-se três contagens consecutivas. Na sequencia, os animais de cada rebanho foram divididos em dois grupos de seis bovinos cada, sendo um tratado com ivermectina 500mcgkg-1 via pour-on e outro mantido como controle. Quatorze dias depois do tratamento, os bovinos foram submetidos à eutanásia para contagem de endoparasitas. A ivermectina demonstrou resultados nulos de eficácia contra H. placei nos quatro rebanhos. Contra C. punctata, tal formulação teve eficácia nula nos rebanhos provenientes de Jaboticabal,SP, e de Formiga,MG, e eficácias de 75,8% e 58,4% nos rebanhos provenientes de São José do Rio Pardo,SP, e de São Sebastião do Paraíso,MG, respectivamente. Valores de eficácia de 94,2% (Jaboticabal), 0,0% (São José do Rio Pardo), 94,2% (Formiga) e 39,2% (São Sebastião do Paraíso) foram detectados contra O. radiatum. Com base nos resultados encontrados, pode-se concluir que as quatro populações de Haemonchus placei e de Cooperia punctata avaliadas foram resistentes à ivermectina, administrada via pour-on, 500mcgkg-1. Foram observadas cepas de Oesophagostomum radiatum resistentes à ivermectina em dois dos quatro rebanhos testados.(AU)
The broad spectrum of endectocides and the easy use mode of their pour-on formulations are factors that have stimulated a higher frequency of use these drugs in cattle. In this study was evaluated the efficacy of ivermectin pour-on using the dose of 500mcgkg-1, against nematodes in naturally infected cattle from different herds. Twelve calves were brought from each of the four farms selected. All the 48 calves used showed mean of eggs per gram of feces (EPG) greater than 500 considering three consecutive counts. Subsequently, animals from each herd were divided into two groups of six animals each, one treated pour-on with ivermectin 500mcgkg-1 and other kept as untreated control. Calves were euthanized 14 days after treatment for counting the endoparasites. Ivermectin showed null effect against H. placei in all the herds evaluated. The drug was also ineffective against C. punctata in the herds from Jaboticabal,SP and Formiga,MG, and reached efficacy of 75.8% and 58.4% in herds from São José do Rio Pardo,SP and São Sebastião do Paraíso,MG, respectively. Efficacies of 94.2% (Jaboticabal), 0.0% (São José do Rio Pardo), 94.2% (Formiga) and 39.2% (São Sebastião do Paraíso) were detectedagainst O. radiatum. Based on these results obtained on the present study, the four populations of Haemonchus placei and Cooperia punctata evaluated were resistant to ivermectin pour-on using a dose of 500mcgkg-1. Ivermectin-resistant strains of Oesophagostomum radiatum were found in two of the four herds evaluated.(AU)
Assuntos
Animais , Bovinos , Doenças dos Bovinos , Resistência a Medicamentos , Haemonchus/efeitos dos fármacos , Oesophagostomum/efeitos dos fármacos , Nematoides/efeitos dos fármacosRESUMO
Avaliou-se a eficácia preventiva da ivermectina e da abamectina, administradas em diferentes vias (subcutânea, intramuscular e pour-on) e doses (200 e 500mcg kg-1), contra larvas de Cochliomyia hominivorax em bolsas escrotais de bovinos após a castração. Foram utilizados animais de seis propriedades do estado de São Paulo e Minas Gerais, Brasil. Para cada estudo, selecionou-se de 30 a 45 bovinos não castrados, dependendo do número de grupos. No dia zero do estudo, realizou-se o processo de castração pelo método cruento, sendo os animais tratados após este processo. Avaliou-se a eficácia da ivermectina e da abamectina administradas via pour-on (500mcg kg-1), subcutanea (200mcg kg-1), bem como a eficácia da abamectina pela via intramuscular (200mcg kg-1). Em cada experimento, um grupo de animais foi mantido como controle. Os animais foram avaliados do 3° ao 14° dia após o processo de castração/tratamento. Os valores de eficácia para ambos os princípios ativos foram ≤30% próximos ao 10° dia pós-tratamento (DPT), sendo que, em cinco experimentos, tanto a ivermectina quanto a abamectina, independente da via de administração, foram ineficazes (0,0%) no 10°DPT. Com base nos resultados encontrados no presente estudo, conduzidos em diferentes propriedades da região sudeste do Brasil, tanto a ivermectina quanto a abamectina, quando utilizadas com base no protocolo apresentado, foram consideradas ineficazes na prevenção de miíases escrotais em bovinos, independente da via e dose de administração utilizada.
The preventive efficacy of ivermectin and abamectin administered in different routes (subcutaneous, intramuscular and pour-on) and doses (200 and 500mcg kg-1) against Cochliomyia hominivorax in the scrotal sac of cattle after castration, was evaluated. Animals from six different farms, in the state of São Paulo and Minas Gerais, Brazil were used. For each study, 30-45 uncastrated bulls, depending on the number of groups, were selected. On day zero of the study, the procedure was carried out by the method of bloody castration and the animals were treated after this process. The efficacy of ivermectin and abamectin administered via the pour-on (500mcg kg-1), subcutaneous (200mcg kg-1) as well as the efficacy of abamectin intramuscularly (200mcg kg-1) were evaluated. In each experiment, one group of animals was kept as control. The animals were evaluated from the 3rd to the 14th day after castration process/treatment. The efficacy values for both active principles were ≤30% the next day 10 post-treatment (PT), and in five experiments, both ivermectin and abamectin, regardless of the route of administration, were ineffective (0.0%) on the day 10th PT. Based on the results found in this study, conducted in different properties from southeastern Brazil, both ivermectin and abamectin, when used the protocol presented, were considered ineffective in preventing scrotal myiasis in bulls, irrespective of the route of administration and dose used.
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The goal of this study was to evaluate if the immunohistochemical expression of alpha-3 neuronal nicotinic acetylcholine receptor subunit in sympathetic ganglia remains stable after brain death, determining the possible use of sympathetic thoracic ganglia from subjects after brain death as study group. The third left sympathetic ganglion was resected from patients divided in two groups: BD-organ donors after brain death and CON-patients submitted to sympathectomy for hyperhidrosis (control group). Immunohistochemical staining for alpha-3 neuronal nicotinic acetylcholine receptor subunit was performed; strong and weak expression areas were quantified in both groups. The BD group showed strong alpha-3 neuronal nicotinic acetylcholine receptor expression in 6.55% of the total area, whereas the CON group showed strong expression in 5.91% (p = 0.78). Weak expression was found in 6.47% of brain-dead subjects and in 7.23% of control subjects (p = 0.31). Brain death did not affect the results of the immunohistochemical analysis of sympathetic ganglia, and its use as study group is feasible.
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Morte Encefálica/metabolismo , Gânglios Simpáticos/metabolismo , Neurônios/metabolismo , Mudanças Depois da Morte , Receptores Nicotínicos/biossíntese , Receptores Nicotínicos/genética , Acetilcolina/metabolismo , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Receptores Nicotínicos/metabolismo , Adulto JovemRESUMO
OBJECTIVES: To compare bar displacement and complication rates in three retrospective series of patients operated on by the same surgical team. METHOD: A retrospective medical chart analysis of the three patient series was performed. In the first series, the original, unmodified Nuss technique was performed. In the second, we used the ''third point fixation'' technique,and in the last series, the correction was performed with modifications to the stabilizer and stabilizer position. RESULTS: There were no deaths in any of the series. Minor complications occurred in six (4.9%) patients: pneumothorax with spontaneous resolution (2), suture site infection (2), and bar displacement without the reoperation need (2). Major complications were observed in eight (6.5%) patients: pleural effusion requiring drainage (1), foreign body reaction to the bar (1), pneumonia and shock septic (1), cardiac perforation (1), skin erosion/seroma (1), and displacement that necessitated a second operation to remove the bar within the 30 days of implantation (3). All major complications occurred in the first and second series. CONCLUSION: The elimination of fixation wires, the use of shorter bars and redesigned stabilizers placed in a more medial position results in a better outcome for pectus excavatum patients treated with the Nuss technique. With bar displacement and instability no longer significant postoperative risks, the Nuss technique should be considered among the available options for the surgical correction of pectus excavatum in pediatric patients.
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Migração de Corpo Estranho/diagnóstico por imagem , Tórax em Funil/cirurgia , Fixadores Internos , Complicações Pós-Operatórias/diagnóstico por imagem , Esterno/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Tórax em Funil/diagnóstico por imagem , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Esterno/diagnóstico por imagem , Resultado do Tratamento , Adulto JovemRESUMO
The main objective of this study was to determine if there are variations in the level of improvement of the palmar and plantar hyperhidrotic symptoms, as well as the incidence and intensity of the sudomotor reflex, throughout the seasons of the year, after thoracic sympathectomy for hyperhidrosis. The study also looks for the real impact of these variables in the long-term satisfaction. A cohort of 75 patients was followed through distinct seasons. A multivariate analysis was performed to identify possible variables responsible for dissatisfaction. Both the palmar (P=0.002) and plantar (P<0.001) symptoms and the presence and the intensity of the sudomotor reflex varies significantly throughout the seasons of the year. The sudomotor reflex was the main factor associated with low satisfaction in our patients in the summer (P=0.025) and winter (P<0.001) but in spring the lack of improvement in the hyperhidrosis in the foot was the unique factor related to dissatisfaction (P<0.001). The sudomotor reflex is the main negative factor in the summer and in the winter, independent of its intensity. However, at least in spring, the lack of removal of the plantar symptoms had a negative impact on satisfaction.
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Hiperidrose/cirurgia , Satisfação do Paciente , Reflexo , Sudorese , Simpatectomia/métodos , Brasil , Distribuição de Qui-Quadrado , Pé , Mãos , Humanos , Hiperidrose/fisiopatologia , Estudos Prospectivos , Qualidade de Vida , Estações do Ano , Inquéritos e Questionários , Simpatectomia/efeitos adversos , Vértebras Torácicas , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: To compare bar displacement and complication rates in three retrospective series of patients operated on by the same surgical team. METHOD: A retrospective medical chart analysis of the three patient series was performed. In the first series, the original, unmodified Nuss technique was performed. In the second, we used the ''third point fixation'' technique,and in the last series, the correction was performed with modifications to the stabilizer and stabilizer position. RESULTS: There were no deaths in any of the series. Minor complications occurred in six (4.9 percent) patients: pneumothorax with spontaneous resolution (2), suture site infection (2), and bar displacement without the reoperation need (2). Major complications were observed in eight (6.5 percent) patients: pleural effusion requiring drainage (1), foreign body reaction to the bar (1), pneumonia and shock septic (1), cardiac perforation (1), skin erosion/seroma (1), and displacement that necessitated a second operation to remove the bar within the 30 days of implantation (3). All major complications occurred in the first and second series. CONCLUSION: The elimination of fixation wires, the use of shorter bars and redesigned stabilizers placed in a more medial position results in a better outcome for pectus excavatum patients treated with the Nuss technique. With bar displacement and instability no longer significant postoperative risks, the Nuss technique should be considered among the available options for the surgical correction of pectus excavatum in pediatric patients.
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Adulto Jovem , Migração de Corpo Estranho , Tórax em Funil/cirurgia , Fixadores Internos , Complicações Pós-Operatórias , Esterno/cirurgia , Tórax em Funil , Estudos Retrospectivos , Esterno , Resultado do TratamentoRESUMO
Regional recurrence of breast cancer may involve the surgical site of mastectomy, axillary lymph nodes and the internal mammary lymphatic chain. Treatment of regional recurrent mammary cancer rarely requires thoracic surgery intervention, except in some selected cases of recurrence in the chest wall. Concerning lymphatic recurrence in breast cancer, the therapeutic choice rarely includes surgical lymph node excision. Exclusive videothoracoscopic (VTS) resection of recurrence in internal mammary lymph nodes has not as yet been reported in the literature. Due to the rare surgical exploration of this lymphatic chain, the thoracoscopic approach is described only in three published studies involving humans, furthermore, in these three descriptions, the operation was performed only for mere staging but not for the whole resection of the recurrent lymphatic structure. We present a case of recurrence of breast cancer in lymph nodes of the internal mammary chain that was treated with complete resection by pure VTS surgery.
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Neoplasias da Mama/cirurgia , Carcinoma Lobular/cirurgia , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Mastectomia , Cirurgia Torácica Vídeoassistida , Adulto , Neoplasias da Mama/patologia , Carcinoma Lobular/secundário , Quimioterapia Adjuvante , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Terapia Neoadjuvante , Radioterapia Adjuvante , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Pectus excavatum is a congenital deformity that can require surgical treatment. Since Nuss proposed a correction technique, several modifications have been proposed in order to achieve more safety and efficiency in the placement and removal of both bars. Our objective is to describe the technique of placing and removing the bars by proposing three technical modifications: two in bar placement and one in the bar removal. We describe two cases where Nuss bars were placed and one case where the bar was removed as per the technical modification proposed herein. According to the original technique, bar stabilisers were placed close to the lateral bar edges. We propose a more medial position in order to reduce bar displacement. New stabilisers were designed with central grooves in the posterior surface, which allow better sliding. The technical modification suitable for bar removal was the use of a protective film around the bars to protect the surrounding tissues from the sharp edges, and thereby minimise the risk of injuries. All the proposed modifications were performed without any additional surgical risk or perioperative complication. These three technical modifications can be easily and safely performed, and seem to reduce the risk of bleeding with no additional perioperative complications.
Assuntos
Tórax em Funil/cirurgia , Procedimentos Ortopédicos/instrumentação , Remoção de Dispositivo/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Ortopédicos/métodos , Próteses e Implantes , Desenho de PróteseRESUMO
OBJECTIVES: We developed a prosthesis for open pleurostomy cases where pulmonary decortication is not indicated, or where post-pneumonectomy space infection occurs. The open pleural window procedure not only creates a large hole in the chest wall that is shocking to patients, also results in a permanent deformation of the thorax. prosthesis for open pleurostomy is a self-retained silicone tube that requires the removal of 3 cm of one rib for insertion, and acts as a mature conventional open pleural window. Herein, we report our 13-year experience with this device in the management of different kinds of pleural empyema. METHODS: Forty-four consecutive patients with chronic empyema were treated. The etiology of empyema was diverse: pneumonia, 20; lung resections, 12 (pneumonectomies, 7; lobectomies, 4; non-anatomical, 1); mixed-tuberculous, 6; and mixed-malignant pleural effusion, 6. After debridement of both pleural surfaces, the prosthesis for open pleurostomy was inserted and attached to a small recipient plastic bag. RESULTS: Infection control was achieved in 20/20 (100%) of the parapneumonic empyemas, in 3/4 (75%) of post-lobectomies, in 6/7 (85%) of post-pneumonectomies, in 6/6 (100%) of mixed-tuberculous cases, and in 4/6 (83%) of mixed-malignant cases. Lung re-expansion was also successful in 93%, 75%, 33%, and 40% of the groups, respectively CONCLUSIONS: Prosthesis for open pleurostomy insertion is a minimally invasive procedure that can be as effective as conventional open pleural window for management of chronic empyemas. Thus, we propose that the use of prosthesis for open pleurostomy should replace the conventional method.
Assuntos
Drenagem/instrumentação , Empiema Pleural/cirurgia , Toracostomia/instrumentação , Adolescente , Adulto , Idoso , Doença Crônica , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Toracostomia/métodos , Resultado do Tratamento , Adulto JovemRESUMO
Congenital sternal cleft is a rare disease, and primary repair in the neonatal period is its best management. In 1998 we presented three surgical techniques for sternal cleft correction, but since 1999 we have elected one of them as our procedure of choice. Our latest results are now presented. It is a review of 15 patients operated from October 1979 to December 2007. Surgical repair consisted of 3 sliding chondrotomies, 10 reconstructions based on a 'posterior sternal wall', 1 reconstruction combined to Ravitch operation for pectus excavatum and 1 associated with total repair of Cantrell's pentalogy. Data concerning epidemiological features, surgical reconstruction, aesthetic results, postoperative major complications, mortality and hospital stay, were collected from hospital charts. Follow-up ranged from 4 months to 27 years. All patients submitted to surgical correction had a good aesthetic and functional result. Neither postoperative mortality nor major complication was observed. Two patients had subcutaneous fluid collection that prolonged the drainage duration. The mean hospital stay was 6 days. In conclusion, reconstructing sternal cleft with a 'posterior periosteal flap from sternal bars and chondral graft' is an effective option with good aesthetic and long-term functional results.
Assuntos
Esterno/anormalidades , Esterno/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Satisfação do Paciente , Estudos Retrospectivos , Procedimentos Cirúrgicos Torácicos/métodos , Fatores de Tempo , Adulto JovemRESUMO
Our objective is to compare surgical safety and efficacy between robotic and human camera control in video-assisted thoracic sympathectomy. A randomized-controlled-trial was performed. Surgical operation was VATS sympathectomy for hyperhidrosis. The trial compared a voice-controlled robot for holding the endoscopic camera robotic group (Ro) to human assisted group (Hu). Each group included 19 patients. Sympathectomy was achieved by electrodessication of the third ganglion. Operations were filmed and images stored. Two observers quantified the number of involuntary and inappropriate movements and how many times the camera was cleaned. Safety criteria were surgical accidents, pain and aesthetical results; efficacy criteria were: surgical and camera use duration, anhydrosis, length of hospitalization, compensatory hyperhidrosis and patient satisfaction. There was no difference between groups regarding surgical accidents, number of involuntary movements, pain, aesthetical results, general satisfaction, number of lens cleaning, anhydrosis, length of hospitalization, and compensatory hyperhidrosis. The number of contacts of the laparoscopic lens with mediastinal structures was lower in the Ro group (P<0.001), but the total and surgical length was longer in this group (P<0.001). Camera holding by a robotic arm in VATS sympathectomy for hyperhidrosis is as safe but less efficient when compared to a human camera-holding assistant.
Assuntos
Ganglionectomia/métodos , Hiperidrose/cirurgia , Robótica , Cirurgia Assistida por Computador , Cirurgia Torácica Vídeoassistida , Toracoscópios , Adolescente , Adulto , Feminino , Ganglionectomia/efeitos adversos , Ganglionectomia/instrumentação , Humanos , Masculino , Estudos Prospectivos , Método Simples-Cego , Cirurgia Assistida por Computador/instrumentação , Cirurgia Torácica Vídeoassistida/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: We developed a prosthesis for open pleurostomy cases where pulmonary decortication is not indicated, or where post-pneumonectomy space infection occurs. The open pleural window procedure not only creates a large hole in the chest wall that is shocking to patients, also results in a permanent deformation of the thorax. prosthesis for open pleurostomy is a self-retained silicone tube that requires the removal of 3 cm of one rib for insertion, and acts as a mature conventional open pleural window. Herein, we report our 13-year experience with this device in the management of different kinds of pleural empyema. METHODS: Forty-four consecutive patients with chronic empyema were treated. The etiology of empyema was diverse: pneumonia, 20; lung resections, 12 (pneumonectomies, 7; lobectomies, 4; non-anatomical, 1); mixed-tuberculous, 6; and mixed-malignant pleural effusion, 6. After debridment of both pleural surfaces, the prosthesis for open pleurostomy was inserted and attached to a small recipient plastic bag. RESULTS: Infection control was achieved in 20/20 (100 percent) of the parapneumonic empyemas, in 3/4 (75 percent) of post-lobectomies, in 6/7 (85 percent) of post-pneumectomies, in 6/6 (100 percent) of mixed-tuberculous cases, and in 4/6 (83 percent) of mixed-malignant cases. Lung re-expansion was also successful in 93 percent, 75 percent, 33 percent, and 40 percent of the groups, respectively CONCLUSIONS: Prosthesis for open pleurostomy insertion is a minimally invasive procedure that can be as effective as conventional open pleural window for management of chronic empyemas. Thus, we propose that the use of prosthesis for open pleurostomy should replace the conventional method.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Drenagem/instrumentação , Empiema Pleural/cirurgia , Toracostomia/instrumentação , Doença Crônica , Drenagem/métodos , Implantação de Prótese , Resultado do Tratamento , Toracostomia/métodos , Adulto JovemRESUMO
OBJECTIVE: Bronchial typical carcinoid tumors are low-grade malignancies. However, metastases are diagnosed in some patients. Predicting the individual risk of these metastases to determine patients eligible for a radical lymphadenectomy and patients to be followed-up because of distant metastasis risk is relevant. Our objective was to screen for predictive criteria of bronchial typical carcinoid tumor aggressiveness based on a logistic regression model using clinical, pathological and biomolecular data. METHODS: A multicenter retrospective cohort study, including 330 consecutive patients operated on for bronchial typical carcinoid tumors and followed-up during a period more than 10 years in two university hospitals was performed. Selected data to predict the individual risk for both nodal and distant metastasis were: age, gender, TNM staging, tumor diameter and location (central/peripheral), tumor immunostaining index of p53 and Ki67, Bcl2 and the extracellular density of neoformed microvessels and of collagen/elastic extracellular fibers. RESULTS: Nodal and distant metastasis incidence was 11% and 5%, respectively. Univariate analysis identified all the studied biomarkers as related to nodal metastasis. Multivariate analysis identified a predictive variable for nodal metastasis: neo angiogenesis, quantified by the neoformed pathological microvessels density. Distant metastasis was related to male gender. DISCUSSION: Predictive models based on clinical and biomolecular data could be used to predict individual risk for metastasis. Patients under a high individual risk for lymph node metastasis should be considered as candidates to mediastinal lymphadenectomy. Those under a high risk of distant metastasis should be followed-up as having an aggressive disease. CONCLUSION: Individual risk prediction of bronchial typical carcinoid tumor metastasis for patients operated on can be calculated in function of biomolecular data. Prediction models can detect high-risk patients and help surgeons to identify patients requiring radical lymphadenectomy and help oncologists to identify those as having an aggressive disease requiring prolonged follow-up.