RESUMO
Background: Since its first description, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of adrenal tumors. In patients who have previously undergone major transperitoneal or retroperitoneal surgeries, a retroperitoneal access through a virgin thoracic cavity might be the only alternative for a minimally invasive approach. Case Presentation: We report a case of a 61-year-old man with a history of retroperitoneal nephrectomy caused by renal cell carcinoma. He then developed a cancer recurrence in the left renal fossa, which was rescued with a transperitoneal laparotomy. During surveillance, a CT scan revealed two lung nodules and an adrenal tumor, a biopsy of which confirmed as relapsed kidney cancer. The patient had a good performance status so pazopanib (800 mg/day) was initiated, with a partial response in the adrenal tumor. Considering the patient's background, he was regarded as an appropriate candidate for a thoracoscopic transdiaphragmatic adrenalectomy. The patient was operated under general anesthesia, with selected double-lumen endotracheal intubation in lateral decubitus position. Once transthoracic ports were placed, the diaphragm was incised, exposing the retroperitoneal space. At this stage, the adrenal mass was identifiable and dissected free from surrounding structures. There were no intraoperative and postoperative complications. The patient was discharged after surgery without opioid requirement. The pathology report confirmed the relapsed renal cancer with negative surgical margins. The patient was alive and without a kidney cancer relapse at his last follow-up visit. Conclusions: As we described in our case, thoracoscopic transdiaphragmatic adrenalectomy might be taken into consideration in patients with a history of previous major transabdominal or retroperitoneal surgeries. In addition, the lateral decubitus position might be advantageous for anesthetists unfamiliar with the prone position.
RESUMO
El neumotórax catamenial es de rara presentación. Su curso clínico es variable, y generalmente recurre. Presentamos un caso en una paciente de 35 años con cinco episodios de neumotórax tratados en otra institución. Se diagnosticó y resolvió por videotoracoscopia. Realizamos plicatura diafragmática y pleurodesis. La anatomía patológica confirmó el diagnóstico. Presenta muy buena evolución sin recidivas hasta el día de la fecha. Esta entidad nosológica debe ser considerada en todo neumotórax recidivante de la mujer con periodos menstruales.
Catamenial pneumothorax is of rare presentation. Its clinical course is variable, and it usually recurs. We present a case of a 35 year-old patient with five episodes of pneumothorax previously treated in another institution. Videothoracoscopy was used for diagnosis and treatment, which included a diaphragmatic plication followed by pleurodesis. The anatomopathology confirmed the diagnosis. Postoperative curse was uneventful up to date. Catamenial etiology should be considered in all recurrent pneumothorax occurring in women with menstrual periods.
Assuntos
Humanos , Pneumotórax , Terapêutica , Pleurodese , Diagnóstico , Anatomia , Cooperação InternacionalRESUMO
PURPOSE: Based on our preclinic studies with autologous unfractionated bone marrow (AUBM) via coronary sinus with transitory occlusion, a clinic study in patients with chronic refractory angina was designed. The objectives were to evaluate tolerance of the procedure, safety, and feasibility with 1 year follow-up. METHODS AND MATERIALS: Clinical study with inclusion and exclusion criteria defined by an Independent Clinical Committee was carried out. Fifteen patients underwent transcoronary sinus administration with a 15-min occlusion of freshly aspirated and filtered AUBM (60-120 ml). Feasibility was evaluated with Seattle Angina Questionnaire (SAQ), Canadian Cardiovascular Society (CCS) angina classification, perfusion dipyridamole, and coronary angiography. RESULTS: There were no changes in the tolerance parameters. There were no deaths or myocardial infarction during the follow-up. Three patients were readmitted into the hospital. During the follow-up, one patient was diagnosed with cancer of the lung. Improvement of 30% in the quality of life was evaluated by SAQ. The CCS angina classification showed that the mean angina class was 3.0+/-0.53 at baseline, which improved to 1.6+/-0.63 at 1 year (P<.001). Perfusion imaging (core lab) showed improvement in 12 of 15 patients, with a mean improvement of 40.9% at rest (22 vs. 13) (P<.01) and 45.3% at stress (26.5 vs. 14.5) (P<.05). Coronary angiography showed more collateral vessels in 10 of 15 patients. CONCLUSIONS: We can conclude that AUBM via coronary sinus is feasible in patients with chronic refractory angina after 1 year follow-up, and it appears to be safe.