RESUMO
OBJECTIVE: To conduct a systematic review of the literature on patients with extrapelvic deep endometriosis. DATA SOURCES: A thorough search of the PubMed/Medline, Embase, and Cochrane databases was performed. METHODS OF STUDY SELECTION: Studies in the last 20 years that reported on primary extrapelvic endometriosis were included (PROSPERO registration number CRD42019125370). TABULATION, INTEGRATION, AND RESULTS: The initial search identified 5465 articles, and 179 articles, mostly case reports and series, were included. A total of 230 parietal (PE), 43 visceral (VE), 628 thoracic (TE), 6 central nerve system, 12 extrapelvic muscle or nerve, and 1 nasal endometriosis articles were identified. Abdominal endometriosis was divided into PE and VE. PE lesions involved primary lesions of the abdominal wall, groin, and perineum. When present, symptoms included a palpable mass (99%), cyclic pain (71%) and cyclic bleeding (48%). Preoperative clinical suspicion was low, the use of tissue diagnosis was indeterminate (25%), and a few (8%) malignancies were suspected. Surgical treatment for PE included wide local excision (97%), with 5% recurrence and no complications. Patients with VE involving abdominal organs - kidneys, liver, pancreas, and biliary tract - were treated surgically (86%) with both conservative (51%) and radical resection (49%), with 15% recurrence and 2 major complications reported. In patients with TE involving the diaphragm, pleura, and lung, isolated and concomitant lesions occurred and favored the right side (80%). Patients with TE presented with the triad of catamenial pain, pneumothorax, and hemoptysis. Thoracoscopy with resection followed by pleurodesis was the most common procedure performed, with 29% recurrence. Adjuvant medical therapy with gonadotropin-releasing hormone was administered in 15% of cases. Preoperative magnetic resonance imaging was performed in all cases of nonthoracic and nonabdominal endometriosis. Common symptoms were paresthesia and cyclic pain with radiation. Surgical resection was reported in 84%, with improvement of symptoms. CONCLUSION: Extrapelvic endometriosis, traditionally thought to be rare, has been reported in a considerable number of cases. Heightened awareness and clinical suspicion of the disease and a multidisciplinary approach are recommended to achieve a prompt diagnosis and optimize patient outcomes. Currently, there are no comparative studies to provide recommendations regarding optimal diagnostic methods, treatment options, and outcomes for endometriosis involving extrapelvic sites.
Assuntos
Endometriose/epidemiologia , Gastroenteropatias/epidemiologia , Doenças Musculares/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Doenças Torácicas/epidemiologia , Adulto , Diafragma/patologia , Diafragma/cirurgia , Endometriose/diagnóstico , Endometriose/patologia , Endometriose/terapia , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/patologia , Gastroenteropatias/terapia , Humanos , Imageamento por Ressonância Magnética , Doenças Musculares/diagnóstico , Doenças Musculares/patologia , Doenças Musculares/terapia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/patologia , Doenças do Sistema Nervoso/terapia , Pneumotórax/diagnóstico , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Pneumotórax/terapia , Recidiva , Doenças Torácicas/diagnóstico , Doenças Torácicas/patologia , Doenças Torácicas/terapia , ToracoscopiaRESUMO
The finding of pulmonary nodules in computed tomography is extremely common, with a reported prevalence ranging between 8 percent and 51 percent in volunteers, usually around 25 percent. Of these, about 2 percent to 13 percent are malignant nodules. Age, medical records of extra thoracic cancer existing 5 years before nodule detection, spiculated edges, big size, upper location and a recorded history of tobacco consumption are major risk factors for malignancy. Among these, smoking is one of the most common, with a known increased risk of malignancy (Odds ratio= 2.2). Working with the hypothesis that in smokers a higher prevalence of lesions is expected when compared to the normal population, we conducted a thoracic computed tomography study in 239 volunteers over 38 years (103 men and 135 women), who had been consuming more than 15 cigarettes a day over more than 10 years. Data were analyzed with statistical parametric and multivariate analyses. Some types of lesions were found in 82.5 percent of men and in 87.4 percent of women, being lung (53.7 percent) and mediastinal (13.8 percent) injuries the most frequent ones. Among these, bulls, scars, mediastinal lymphadenopathy and nodules constituted the main lesions (between 21.4 percent and 44.7 percent of the injuries). Nodules accounted for 21.4 percent of lesions in men and 25.2 percent in women, which falls within the normal range as described in volunteers. The cluster analysis, applied in conjunction with Jaccard coefficient of association, showed that nodules do not exist in isolation but in conjunction with other signs, forming a cluster that contains bulls, nodules, scars, mediastinal lymphadenopathy, aortic calcifications, and pleural thickening. Among lesions of potential oncological relevance, an overall finding of 5.83 percent in men and 4.44 percent in women is documented. Solitary nodules were found in 12 males and in 29 females, of whom 7 (58.3 percent) and 10 (34.5 percent), respectively...
El hallazgo de nodulos pulmonares en tomografía computada es extremadamente común, habiéndose reportado prevalencias entre 8 y 51 por ciento en voluntarios, habitualmente alrededor de 25 por ciento; de éstos, 2 a 13 por ciento serían malignos. La edad, antecedente de cáncer extratorácico más de 5 años antes del nodulo, bordes espiculados, gran tamaño, localizador superior y antecedente de consumo de cigarrillos son los principales factores de riesgo de malignidad. El cigarrillo es uno de los más comunes, con conocido aumento del riesgo (Odds ratio= 2.2). Trabajando con la hipótesis que en fumadores se espera mayor prevalencia de lesiones que en la población normal, estudiamos con tomografía computada de tórax 239 voluntarios mayores de 38 años (103 hombres, 135 mujeres), consumidores de más de 15 cigarrillos diarios por más de 10 años. Se analizaron los datos con estadística paramétrica habitual y multivariada. Encontramos 82,5 por ciento hombres y 87,4 por ciento mujeres con alguna lesión; las más frecuentes: pulmonares (53,7 por ciento) y mediastínicas (13,8 por ciento); las principales: bulas, cicatrices, adenopatías mediastínicas y nodulos (21,4 a 44,7 por ciento de las lesiones). Los nodulos correspondieron a 21,4 por ciento de las lesiones en hombres y 25,2 por ciento en mujeres, en rango habitual para lo descrito en voluntarios. El análisis de conglomerados con índice de asociación Jaccard mostró: los nodulos no se presentan aislados, evidenciándose un conglomerado que contiene: bulas, nodulos, cicatrices, adenopatías mediastínicas, calcificaciones aórticas y engrosamiento pleural. Entre las lesiones de posible importancia oncológica destacan: 5,83 por ciento en hombres y 4,44 por ciento en mujeres; 12 nodulos solitarios en hombres y 29 en mujeres, de los cuales 7 (6,8 por ciento) y 10 (7,4 por ciento) constituirían indicaciones de acciones diagnóstico-terapéuticas de mayor agresividad.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doenças Torácicas , Tomografia Computadorizada por Raios X , Tabagismo , Distribuição por Sexo , Doenças Torácicas/epidemiologia , Estudos Prospectivos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares , Nódulo Pulmonar Solitário , Programas de Rastreamento/métodos , Tabagismo/complicações , Tabagismo/epidemiologiaRESUMO
Nos propusimos hacer un estudio comparativo, en los Hospitales Universitarios Joaquín Albarrán Domínguez y General Calixto García Iñiguez, para comparar los resultados inmediatos de la cirugía torácica no cardíaca en pacientes menores y mayores de 60 años, en un período de 7 años (1996 a 2002). Evaluamos la totalidad de los pacientes intervenidos quirúrgicamente por enfermedades torácicas no cardíacas, y tomamos en cuenta las conductas preoperatorias, transoperatorias y posoperatorias, así como la evolución del paciente y su estado al egreso. Encontramos predominio de los pacientes menores de 60 años, entre los cuales prevalecieron los del sexo femenino, y no ocurrió así entre los mayores de 60 años, grupo en el cual predominó el sexo masculino. En general, los pacientes mayores de 60 años eran más saludables, pues se registró en este grupo el mayor porcentaje de personas sin antecedentes patológicos o factores de riesgo. Los diagnósticos que más frecuentemente motivaron la intervención quirúrgica fueron el cáncer de pulmón y el de esófago. Paradójicamente, hubo un mayor porcentaje de complicaciones y de fallecimientos entre los pacientes menores de 60 años(AU)
A comparative study was made at Joaquín Albarrán Domínguez and General Calixto García Iñiguez hospitals to compare the inmediate results of noncardiac thoracic surgery in patients under and over 60 in a period of 7 years (1996 to 2002). All the patients that underwent surgery due to noncardiac thoracic diseases were evaluated, and the preoperative, transoperative and postoperative behaviors, as well as the patients evolution and their state on discharge, were taken into consideration. It was found a predominance of patients under 60 , among whom females prevailed; whereas those over 60 were mostly males. Generally, patients over 60 were healthier, since in this group, most of the patients had neither pathogical history nor risk factors. The diagnoses that led more frequently to surgery were lung and esophagus cancer. Paradoxically, a higher percentage of complications and deaths was observed among patients under 60(AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Doenças Torácicas/epidemiologia , Cirurgia Torácica/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Fatores de RiscoRESUMO
The Video Assisted Thoracic Surgery (VATS) was introduced in Brazil in 1992 by Losso, Ghefter and Imaeda. Since its advent up to November 1994, 488 patients have been submitted to 497 VATS procedures in four Medical Centers of São Paulo city. The indications for the procedures were: lung diseases in 244 patients (50%), pleural disease in 155 patients (31.7%), thoracic traumas in 42 patients (8.6%), mediastinal diseases in 35 patients (7.1%), cardiovascular diseases in 7 patients (1.4%), chest wall diseases in 3 patients (0.6%) and esophageal diseases in 2 patients (0.4%). In the group of lung disease the most commonly used procedures were the lung biopsy in order to diagnose diffuse pulmonary disease and the indeterminate solitary nodule resection. Among the occurrences of pleural diseases, the most commonly used procedures were the pleurodesis with talc (talc poudrage) for the treatment of recurrent pleural effusion, the driven pleura biopsy and debridment or decortication of trapped lung in cases of pleural empyema. Concerning the mediastinal diseases, the pathology which was most frequently treated by VATS was the recurrent pericardic effusion through partial pericardiectomy. Among the patients presenting chest traumatic diseases, the VATS was used to explore thoracoabdominal penetrating injuries, to control bleeding, to remove clotted hemothorax, to suture diaphragm lesions and to remove intrapleural foreign bodies. Out of 497 procedures, there were 28 convertions to thoracotomy (5.7%) and two deaths occurred all over the cases. The complications, limitations and growth related to this method as well as a future overview of the VATS in Brazil will be presented.
Assuntos
Endoscopia , Procedimentos Cirúrgicos Torácicos , Brasil/epidemiologia , Endoscopia/estatística & dados numéricos , Humanos , Doenças Torácicas/epidemiologia , Doenças Torácicas/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Procedimentos Cirúrgicos Torácicos/estatística & dados numéricos , Toracoscopia , Gravação em VídeoRESUMO
OBJECTIVES: 1. To describe the frequency in which the thorax radiography is requested in a third-level pediatric hospital, 2. To identify the frequency of detected abnormalities in such a study by the radiology service, 3. To describe the frequency and the characteristics form the information considered as useful in a clinical way, not only in the radiography application but in the radiologic report and the clinical file as well, 4. To identify the frequency in which the thorax radiography result is associated with diagnosis changes and/or therapeutic ones. DESIGN OF THE INVESTIGATION: Descriptive survey. STUDY UNITS: 371 thorax X-rays completed during December 1990 and January 1991. PRIMARY RESULTS: The thorax radiographies were 32% of the entire radiological study during the survey; 335 of the latter ones (90%) were requested for inpatients. The hospital services which had the highest request for such a study were the Intensive Care Unit (n = 149, 40%) and Medical Pediatrics (n = 116, 31%). The most frequent diagnosis leading to the application was pneumonia (n = 55, 15%) and solid neoplasia (n = 51, 14%). Three-hundred forty eight of the applications had diagnostic impression given by the physician in charge(94%); whereas only 127 (34%) mentioned clinical data. The radiology report was attached to the file in 162 (44%) of the cases. It was found that form the patients who had a radiology report and the thorax radiography as an initial study (n = 95), 48 (50%) suffered from abnormalities. The results of the study were transcribed in the file in 58 cases (16%); the physician's interpretation was written down in 229 cases (62%) and in 84 studies (23%) there was no reference to the results of the study (P < 0.0001). Changes in the therapeutic plan of 93 cases (50%) were identified from the studies with official report by the radiologist, other radiology studies were requested in 65 of the patients (35%), after the interpretation of such study. CONCLUSIONS: Abnormalities in 50% were identified from the total thorax radiographies requested as the patient entered. The study application mentioned as a whole (94%) the diagnostic impression which led to the application, but only in 127 cases (34%) were supporting clinical data written down. The radiology report was attached to the file in less than half the cases (44%). In 63% of the cases the supporting reason of the study was written down whereas in 23% there was no reference to the result at all.