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1.
Chirurgia (Bucur) ; 119(4): 393-403, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39250609

RESUMO

BACKGROUND AND OBJECTIVES: The efficacy and safety of video-assisted thoracoscopic surgery (VATS) versus open thoracotomy in the treatment of non-small cell lung cancer (NSCLC) were evaluated with a focus on mediastinal lymph node dissection, postoperative recovery, and longterm outcomes including survival rates and disease-free intervals. Materials and Methods: This retrospective study analyzed data from 228 NSCLC patients treated at the Institute of Oncology Bucharest from 2016 to 2022. Both VATS and open surgical approaches were compared, with variables including demographic data, comorbidities, surgical outcomes, and postoperative complications meticulously recorded. Statistical significance was assessed using chi-square and independent samples t-tests. Results: Among the findings, VATS demonstrated significantly better two-year progression-free survival rates for patients in early stages (Stages 1-3) of NSCLC compared to open surgery, with p-values 0.01 and 0.001, respectively. In contrast, no significant difference was observed in Stage 4. Furthermore, VATS resulted in shorter operative times (mean 299 vs. 347 minutes, p 0.001), less estimated blood loss (98.68 mL vs. 160.88 mL, p 0.001), reduced chest tube duration (5.78 days vs. 12.17 days, p 0.001), and decreased hospital stays (12.0 days vs. 27.7 days, p 0.001). Conclusions: VATS is associated with improved long-term disease-free survival for early-stage NSCLC and more favorable short-term surgical outcomes, highlighting its advantages over open thoracotomy. Despite its benefits, VATS did not significantly reduce postoperative complications compared to open surgery.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Excisão de Linfonodo , Estadiamento de Neoplasias , Duração da Cirurgia , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Toracotomia , Humanos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Cirurgia Torácica Vídeoassistida/métodos , Estudos Retrospectivos , Masculino , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Feminino , Pessoa de Meia-Idade , Toracotomia/métodos , Idoso , Resultado do Tratamento , Pneumonectomia/métodos , Pneumonectomia/mortalidade , Excisão de Linfonodo/métodos , Taxa de Sobrevida , Adulto , Romênia/epidemiologia , Intervalo Livre de Doença , Tempo de Internação/estatística & dados numéricos
2.
Braz J Cardiovasc Surg ; 39(5): e20230403, 2024 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-39241201

RESUMO

INTRODUCTION: With the introduction of minimally invasive cardiac surgery, more commonly cases of lung herniation are starting to appear. Acquired lung hernias are classified as postoperative, traumatic, pathologic, and spontaneous. Up to 83% of lung hernias are intercostal. Herein, we describe patients presenting with intercostal lung hernias following minimally invasive cardiac surgery at a single center in Medellín, Colombia. METHODS: We conducted a retrospective search of all patients presenting with intercostal lung hernias secondary to minimally invasive cardiac surgery at our clinic in Medellín since the beginning of our program, from 2010 to 2022. Mini-sternotomies were excluded from our study. We reviewed the incision type and other possible factors leading to intercostal lung hernia development. We also describe the approach taken for these patients. RESULTS: From 2010 up until 2022, 803 adult patients underwent minimally invasive cardiac surgeries through a mini-thoracotomy. At the time of data retrieval, nine patients presented with intercostal lung hernias at the previous incision site. Five hernias (55%) were from right 2nd intercostal parasternal mini-thoracotomies for aortic valve surgeries. Four hernias (45%) were from right 4th intercostal lateral mini-thoracotomies for mitral valve surgeries. Our preferred repair technique is a video-assisted thoracoscopic mesh approach. CONCLUSION: Minimally invasive cardiac surgical approaches are becoming more routine. Proper wound closure is critical in preventing lung hernias. Additionally, timely diagnosis and opportune hernia surgery using video-assisted thoracoscopic mesh repair can prevent further complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Pneumopatias , Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Idoso , Pneumopatias/etiologia , Pneumopatias/cirurgia , Toracotomia/efeitos adversos , Toracotomia/métodos , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Hérnia/etiologia , Adulto , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Complicações Pós-Operatórias/etiologia
3.
J Cardiothorac Surg ; 19(1): 511, 2024 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-39227874

RESUMO

BACKGROUND: Video-assisted thoracic surgery (VATS) is widely used for thoracic lesions in pediatric patients. VATS is also applied to pediatric mediastinal tumors if there is no adhesion or invasion between the tumor and adjacent neuronal and cardiovascular structures. Here, we present a pediatric case of mediastinal teratoma in which the tumor adhered to the superior vena cava, and resection was safely completed using assisted VATS, an integrated surgical approach comprising mini-thoracotomy with video assistance. CASE PRESENTATION: A 9 year-old girl presented with right shoulder pain. Chest radiography and computed tomography revealed a 5.4 × 5.1 × 5.8 cm mass in the right upper anterior mediastinum. She was presumed with a mature teratoma, and resection was performed by assisted VATS with muscle sparing axillar skin crease incision (MSASCI) for a mini-thoracotomy. The procedure was safely completed, with the patient discharged on postoperative day 5. At 1 year postoperatively, there was no recurrence with excellent motor and cosmetic results. CONCLUSIONS: The combination of MSASCI and VATS would be useful not only for mediastinal teratomas but also for other mediastinal tumors and almost all other thoracic lesions in pediatric patients.


Assuntos
Neoplasias do Mediastino , Teratoma , Cirurgia Torácica Vídeoassistida , Humanos , Neoplasias do Mediastino/cirurgia , Neoplasias do Mediastino/diagnóstico por imagem , Teratoma/cirurgia , Teratoma/diagnóstico por imagem , Feminino , Cirurgia Torácica Vídeoassistida/métodos , Criança , Tomografia Computadorizada por Raios X , Toracotomia/métodos
4.
J Investig Med High Impact Case Rep ; 12: 23247096241274510, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39230157

RESUMO

Mediastinal mature cystic teratomas are rare benign germ cell tumors that predominantly affect children. Despite their low incidence, they present unique diagnostic and management challenges. Early recognition and appropriate surgical intervention are crucial for optimal outcomes. This case report aims to highlight the importance of prompt diagnosis and management of mediastinal mature cystic teratomas in pediatric patients. We present the case of a 10-year-old female patient who presented with persistent chest pain and dyspnea. Imaging studies, including a chest X-ray and contrast-enhanced chest CT scan, revealed a large, well-circumscribed anterior mediastinal mass with calcifications. The patient underwent a right thoracotomy, resulting in the excision of a 6 × 5 × 5 cm mature cystic teratoma. Histopathological examination confirmed the diagnosis. The patient had an uneventful recovery and was discharged in stable condition. Mediastinal mature cystic teratomas pose diagnostic challenges due to their nonspecific symptoms and heterogeneous imaging characteristics. Differential diagnosis includes other mediastinal masses containing fat and calcifications. Surgical excision is the preferred treatment, although complete removal can be challenging due to adhesions to neighboring structures. Close follow-up is necessary to monitor for recurrence and complications. Mediastinal mature cystic teratomas are rare tumors with variable clinical presentations. Early detection and surgical intervention are crucial for optimal outcomes. These tumors should be included in the list of differential diagnoses for mediastinal masses in pediatric patients.


Assuntos
Neoplasias do Mediastino , Teratoma , Tomografia Computadorizada por Raios X , Humanos , Teratoma/cirurgia , Teratoma/diagnóstico por imagem , Teratoma/diagnóstico , Teratoma/patologia , Feminino , Neoplasias do Mediastino/cirurgia , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/diagnóstico por imagem , Criança , Diagnóstico Diferencial , Toracotomia , Dor no Peito/etiologia , Mediastino/patologia , Mediastino/diagnóstico por imagem , Mediastino/cirurgia
5.
Rev Col Bras Cir ; 51: e20243748, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-39258626

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 , Adulto
6.
J Cardiothorac Surg ; 19(1): 519, 2024 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-39251978

RESUMO

BACKGROUND: Mega-aortic syndrome including aortic arch and descending aortic aneurysm is a challenging surgical case. Because the aorta continuously dilates, creating the distal anastomosis sites becomes an issue. Despite the developments in endovascular techniques including frozen elephant trunk, in the case of mega-aortic syndrome or mycotic aneurysm, extensive surgical repair is still a strong armamentarium. Our patient had a mega-aorta with chronic aortic dissection. Herein, we show tips regarding concurrent ascending, aortic arch, and descending aortic replacement via posterolateral thoracotomy for this relatively young patient. CASE PRESENTATION: A 46-year-old man with chronic kidney disease had chronic type A aortic dissection with an extensively dilated thoracic aorta from the distal ascending to the descending aorta measuring 63 mm in diameter and abdominal aorta measuring 50 mm. The short segment of the distal descending aorta was narrowed to 36 mm. The patient underwent a concurrent replacement of the distal ascending aorta, aortic arch, and descending aorta via a posterolateral thoracotomy. The patient was extubated on postoperative day (POD) 1 and discharged home without serious complications such as stroke, respiratory failure, or renal failure on POD 18. The 1-year follow-up computed tomography did not find issues in the anastomosis sites; however, the abdominal aorta enlarged from 50 to 58 mm. The patient underwent a thoracoabdominal aortic replacement and recovered well without any complications. CONCLUSIONS: Good exposure and meticulous organ protection methods are key to a safe concurrent replacement of the ascending, aortic arch, and descending aorta via posterolateral thoracotomy.


Assuntos
Aorta Torácica , Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Toracotomia , Humanos , Masculino , Pessoa de Meia-Idade , Dissecção Aórtica/cirurgia , Dissecção Aórtica/complicações , Toracotomia/métodos , Aorta Torácica/cirurgia , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Implante de Prótese Vascular/métodos , Tomografia Computadorizada por Raios X , Doença Crônica
7.
J Cardiothorac Surg ; 19(1): 506, 2024 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-39215324

RESUMO

BACKGROUND: Aortic regurgitation with dilated annulus presents a technical challenge for conventional transcatheter aortic valve implantation (TAVI) procedures. CASE PRESENTATION: We report a case of an 84-year-old frail patient with a history of breathlessness found to have severe aortic regurgitation and moderately impaired left ventricular systolic function. The patient underwent a successful TAVI procedure using the XL-Myval 32 mm transcatheter heart valve (THV) via an anterior right mini-thoracotomy with a direct aortic approach. The patient recovered well post-operatively with good hemodynamic resolution. CONCLUSIONS: This first in human case highlights the efficacy and potential of applying innovative approaches, such as the new sizes of Myval THV and direct aortic access via anterior right mini thoracotomy, in addressing challenging anatomical variations in TAVI procedures with good outcome.


Assuntos
Insuficiência da Valva Aórtica , Toracotomia , Substituição da Valva Aórtica Transcateter , Humanos , Insuficiência da Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Toracotomia/métodos , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Masculino , Próteses Valvulares Cardíacas
8.
Zentralbl Chir ; 149(4): 368-377, 2024 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-39111302

RESUMO

Severe thoracic trauma can occur as a penetrating or blunt mono-injury or as part of a polytrauma. Almost half of all severely injured patients documented in the TraumaRegister DGU were diagnosed with severe chest trauma, defined according to the Abbreviated Injury Scale (AIS) as ≥ 3. In our own collective, the proportion was even higher with 60%. Emergency surgical treatment with a thoracotomy within the Trauma Resuscitation Unit or within the first hour of admission is an extremely rare intervention in Germany, accounting for 0.9% of severe thoracic injuries. The management of complex polytraumas and extensive pathophysiological reactions to the trauma, as well as knowledge about the development of secondary damage have led to the conclusion that minimally invasive procedures such as video-assisted thoracoscopy (VATS) or inserting a chest drain can resolve most severe thoracic injuries. At < 4%, penetrating injuries to the thorax are a rarity. Among blunt thoracic injuries, > 6% show an unstable thoracic wall that requires surgical reconstruction. The demographic development in Germany leads to a shift in injury pattern. Low-energy trauma results have lower incidence than higher-grade chest wall injuries with penetrating rib fractures in the pleura, lungs, peri-/myocardium and diaphragm. Sometimes this results in instability of the chest wall with severe restriction of respiratory mechanics, which leads to fulminant pneumonia and even ARDS (Acute Respiratory Distress Syndrome). With this background, surgical chest wall reconstruction has become increasingly important over the past decade. Together with the underlying strong evidence, the assessment of the extend and severity of the trauma and the degree of respiratory impairment are the basis for a structured decision on a non-surgical or surgical-reconstructive strategy, as well as the timing, type and extent of surgery. Early surgery within 72 hours can reduce morbidity (pneumonia rate, duration of intensive care and ventilation) and mortality. In the following article, evidence-based algorithms for surgical and non-operative strategies are discussed in the context on the management of severe thoracic injuries. Thus, a selective literature search was carried out for the leading publications on indications, treatment strategy and therapy recommendations for severe thoracic injury, chest wall reconstruction.


Assuntos
Traumatismo Múltiplo , Traumatismos Torácicos , Traumatismos Torácicos/cirurgia , Humanos , Alemanha , Traumatismo Múltiplo/cirurgia , Contraindicações de Procedimentos , Cirurgia Torácica Vídeoassistida , Toracotomia/métodos , Escala Resumida de Ferimentos , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia
9.
Pediatr Surg Int ; 40(1): 240, 2024 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-39172194

RESUMO

PURPOSE: This study aimed to clarify surgical complications associated with open surgery for congenital diaphragmatic hernia (CDH). METHODS: We performed an exploratory data analysis of the clinical characteristics of surgical complications of neonates with CDH who underwent laparotomy or thoracotomy between 2006 and 2021. Data of these patients were obtained from the database of the Japanese CDH Study Group. RESULTS: Among 1,111 neonates with left or right CDH, 852 underwent open surgery (laparotomy or thoracotomy). Of these 852 neonates, 51 had the following surgical complications: organ injury (n = 48; 6% of open surgeries); circulatory failure caused by changes in the organ location (n = 2); and skin burns (n = 1). Injured organs included the spleen (n = 30; 62% of organ injuries), liver (n = 7), lungs (n = 4), intestine (n = 4), adrenal gland (n = 2), and thoracic wall (n = 2). Fourteen of the patients who experienced organ injury required a blood transfusion (2% of open surgeries). The adjusted odds ratio of splenic injury for patients with non-direct closure of the diaphragm was 2.2 (95% confidence interval, 1.1-4.9). CONCLUSION: Of the patients who underwent open surgery for CDH, 2% experienced organ injury that required a blood transfusion. Non-direct closure of the diaphragmatic defect was a risk factor for splenic injury.


Assuntos
Hérnias Diafragmáticas Congênitas , Complicações Intraoperatórias , Humanos , Hérnias Diafragmáticas Congênitas/cirurgia , Japão/epidemiologia , Masculino , Feminino , Recém-Nascido , Complicações Intraoperatórias/epidemiologia , Laparotomia/métodos , Toracotomia/métodos , Toracotomia/efeitos adversos , Estudos Retrospectivos
10.
J Med Case Rep ; 18(1): 412, 2024 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-39210384

RESUMO

BACKGROUND: Giant anterior mediastinal masses in infants are one of the most challenging cases faced in pediatric anesthesia practice. They can pose unique challenges for resection such as cardiovascular collapse on induction of anesthesia and injury to surrounding structures that maybe compressed or displaced. Principles that must be followed and kept in mind during removal of giant mediastinal mass include appropriate diagnostic imaging to define mass extent, airway control during induction, a multidisciplinary team approach including cardiothoracic for sternotomy, cannulation to institute cardiopulmonary bypass, otolaryngology for rigid bronchoscopy, preservation of neurovascular structure, and complete resection whenever possible. Our patient had a mass that weighed twice his whole body weight. CASE PRESENTATION: Here we present a 3-month-old Middle Eastern infant weighing 3.2 kg with a large congenital teratoma who presented to the emergency room with cyanosis and respiratory distress. During his hospital course, he underwent three procedures, two of them under light-to-moderate sedation: a diagnostic computer tomography scan followed by mass content drainage by interventional radiology (Figs. 1, 2). On the third day, he had a thoracotomy with complete tumor resection under general anesthesia with the help of an epidural for pain control (Fig. 3). The resected tumor weighed 2.5 kg, which was equal to twice the patient's total body weight (Fig. 4). After the surgery, he was extubated in the operating room and discharged home 3 days later. Fig. 1 Anterior-posterior chest x-ray showing the anterior mediastinal mass (AMM) Fig. 2 Cross-section computed tomography (CT) showing large anterior mediastinal mass (AMM) Fig. 3 Gross anatomy of the tumor before resection Fig. 4 Gross anatomy of the removed tumor CONCLUSION: Anterior mediastinal mass patients can be challenging for the anesthesiologist. They need meticulous thorough perioperative assessment to determine the extent of compression on major intramediastinal structures and to predict the complications. Planning by multidisciplinary team and discussion with the family is important. These types of cases should be preferably operated on by an experienced team in a well-equipped operation room in tertiary care institutes.


Assuntos
Neoplasias do Mediastino , Teratoma , Humanos , Lactente , Masculino , Anestesia Geral/métodos , Neoplasias do Mediastino/congênito , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Teratoma/congênito , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Toracotomia/efeitos adversos , Tomografia Computadorizada por Raios X
12.
Chirurgia (Bucur) ; 119(Ahead of print): 1-11, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39106471

RESUMO

BACKGROUND AND OBJECTIVES: The efficacy and safety of video-assisted thoracoscopic surgery (VATS) versus open thoracotomy in the treatment of non-small cell lung cancer (NSCLC) were evaluated with a focus on mediastinal lymph node dissection, postoperative recovery, and longterm outcomes including survival rates and disease-free intervals. Materials and Methods: This retrospective study analyzed data from 228 NSCLC patients treated at the Institute of Oncology Bucharest from 2016 to 2022. Both VATS and open surgical approaches were compared, with variables including demographic data, comorbidities, surgical outcomes, and postoperative complications meticulously recorded. Statistical significance was assessed using chi-square and independent samples t-tests. Results: Among the findings, VATS demonstrated significantly better two-year progression-free survival rates for patients in early stages (Stages 1-3) of NSCLC compared to open surgery, with p-values 0.01 and 0.001, respectively. In contrast, no significant difference was observed in Stage 4. Furthermore, VATS resulted in shorter operative times (mean 299 vs. 347 minutes, p 0.001), less estimated blood loss (98.68 mL vs. 160.88 mL, p 0.001), reduced chest tube duration (5.78 days vs. 12.17 days, p 0.001), and decreased hospital stays (12.0 days vs. 27.7 days, p 0.001). Conclusions: VATS is associated with improved long-term disease-free survival for early-stage NSCLC and more favorable short-term surgical outcomes, highlighting its advantages over open thoracotomy. Despite its benefits, VATS did not significantly reduce postoperative complications compared to open surgery.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Excisão de Linfonodo , Estadiamento de Neoplasias , Duração da Cirurgia , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Toracotomia , Humanos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Cirurgia Torácica Vídeoassistida/métodos , Estudos Retrospectivos , Masculino , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Feminino , Pessoa de Meia-Idade , Toracotomia/métodos , Idoso , Resultado do Tratamento , Pneumonectomia/métodos , Pneumonectomia/mortalidade , Excisão de Linfonodo/métodos , Taxa de Sobrevida , Adulto , Romênia/epidemiologia , Intervalo Livre de Doença , Tempo de Internação/estatística & dados numéricos
13.
J Med Case Rep ; 18(1): 377, 2024 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-39128992

RESUMO

BACKGROUND: Myelolipoma is an uncommon benign tumor composed of mature adipose tissue and hematopoietic elements. These tumors generally affect the adrenal glands, with anomalous presentations being rare and with few cases described in the literature. Most myelolipomas are asymptomatic and discovered incidentally, either through imaging tests or at autopsies. However, depending on the location and size of the lesion, myelolipomas can cause symptoms of mass effect. This article aims to report a very rare presentation of a symptomatic primary myelolipoma affecting the ribs. CASE PRESENTATION: A 21-year-old white female patient presented with a complaint of burning chest pain over 3 months, with gradual worsening in intensity, accompanied by a progressively growing bulge in the right thoracic wall. The patient underwent thoracotomy of the fifth and sixth ribs with complete excision of the lesion with a safety margin. Thoracic wall reconstruction was performed using a polypropylene mesh. The patient had a good postoperative course and was discharged on postoperative day 3. Histopathological examination revealed a histological image consistent with myelolipoma. CONCLUSIONS: This report underscores the importance of considering a myelolipoma diagnosis for tumor masses in the ribs.


Assuntos
Mielolipoma , Costelas , Humanos , Mielolipoma/cirurgia , Mielolipoma/patologia , Mielolipoma/diagnóstico , Mielolipoma/diagnóstico por imagem , Feminino , Costelas/patologia , Costelas/cirurgia , Costelas/diagnóstico por imagem , Adulto Jovem , Toracotomia , Dor no Peito/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neoplasias Ósseas/cirurgia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/diagnóstico
14.
BMC Med Imaging ; 24(1): 197, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39090610

RESUMO

BACKGROUND: This study was designed to develop a combined radiomics nomogram to preoperatively predict the risk categorization of thymomas based on contrast-enhanced computed tomography (CE-CT) images. MATERIALS: The clinical and CT data of 178 patients with thymoma (100 patients with low-risk thymomas and 78 patients with high-risk thymomas) collected in our hospital from March 2018 to July 2023 were retrospectively analyzed. The patients were randomly divided into a training set (n = 125) and a validation set (n = 53) in a 7:3 ratio. Qualitative radiological features were recorded, including (a) tumor diameter, (b) location, (c) shape, (d) capsule integrity, (e) calcification, (f) necrosis, (g) fatty infiltration, (h) lymphadenopathy, and (i) enhanced CT value. Radiomics features were extracted from each CE-CT volume of interest (VOI), and the least absolute shrinkage and selection operator (LASSO) algorithm was performed to select the optimal discriminative ones. A combined radiomics nomogram was further established based on the clinical factors and radiomics scores. The differentiating efficacy was determined using receiver operating characteristic (ROC) analysis. RESULTS: Only one clinical factor (incomplete capsule) and seven radiomics features were found to be independent predictors and were used to establish the radiomics nomogram. In differentiating low-risk thymomas (types A, AB, and B1) from high-risk ones (types B2 and B3), the nomogram demonstrated better diagnostic efficacy than any single model, with the respective area under the curve (AUC), accuracy, sensitivity, and specificity of 0.974, 0.921, 0.962 and 0.900 in the training cohort, 0.960, 0.892, 0923 and 0.897 in the validation cohort, respectively. The calibration curve showed good agreement between the prediction probability and actual clinical findings. CONCLUSIONS: The nomogram incorporating clinical factors and radiomics features provides additional value in differentiating the risk categorization of thymomas, which could potentially be useful in clinical practice for planning personalized treatment strategies.


Assuntos
Nomogramas , Radiômica , Timoma , Neoplasias do Timo , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Meios de Contraste , Diagnóstico Diferencial , Estudos Retrospectivos , Medição de Risco , Curva ROC , Toracotomia , Timoma/diagnóstico por imagem , Timoma/cirurgia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios X/métodos
15.
ASAIO J ; 70(7): 565-569, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38949771

RESUMO

National trends show rapid increases in the use of mechanical circulatory support devices (MCSD) over the last 20 years. While current literature has not proven a mortality benefit in cardiogenic shock as a complication of acute myocardial infarction (AMI-CS) with percutaneous MCSD, these devices are vital to maximizing cardiopulmonary parameters for definitive therapy. To minimize complications, many different techniques have been described including a novel off-pump direct apical cannulation for venoarterial-extracorporeal membrane oxygenation (VA-ECMO). This technique allows early ambulation and avoids peripheral artery access complications but has only been described in small case series. Our case series represents the largest summary of patients (50) using this technique and contains the only comparison data to date. Fifty-four percentage of our patients were Society for Cardiovascular Angiography and Interventions (SCAI) stage D and 22% were arrested before cannulation. We achieved flows on average >5 L/min and most patients required biventricular drainage (86%) and an oxygenator (92%). Thirty day survival was 56% and most survivors were bridged to heart transplant (30%). Our most common complication was bleeding (16%). This technique showed significant improvement in ejection fraction (EF), cardiac output/index (CO/CI), and pulmonary artery pressures. This case series demonstrates the safety and efficacy of this novel technique for central cannulation in cardiogenic shock at large scale within a single institution.


Assuntos
Cânula , Oxigenação por Membrana Extracorpórea , Choque Cardiogênico , Humanos , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/instrumentação , Pessoa de Meia-Idade , Masculino , Feminino , Choque Cardiogênico/terapia , Choque Cardiogênico/cirurgia , Idoso , Toracotomia/métodos , Toracotomia/efeitos adversos , Cateterismo/métodos , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Adulto , Infarto do Miocárdio , Coração Auxiliar/efeitos adversos
16.
Ann Card Anaesth ; 27(3): 193-201, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38963353

RESUMO

ABSTRACT: With the advancements in regional anesthesia and ultrasound techniques, the use of non-neuraxial blocks like the erector spinae plane block (ESPB) has been increasing in cardiac surgeries with promising outcomes. A total of 3,264 articles were identified through a literature search. Intervention was defined as ESPB. Comparators were no regional technique performed or sham blocks. Four studies with a total of 226 patients were included. Postoperative opioid consumption was lower in the group that received ESPB than the group that did not (weighted mean difference [WMD]: -204.08; 95% CI: -239.98 to -168.19; P < 0.00001). Intraoperative opioid consumption did not differ between the two groups (WMD: -398.14; 95% CI: -812.17 to 15.98; P = 0.06). Pain scores at 0 hours were lower in the group that received ESPB than the group that did not (WMD: -1.27; 95% CI: -1.99 to -0.56; P = 0.0005). Pain scores did not differ between the two groups at 4-6 hours (WMD: -0.79; 95% CI: -1.70 to 0.13; P = 0.09) and 12 hours (WMD: -0.83; 95% CI: -1.82 to 0.16; P = 0.10). Duration of mechanical ventilation in minutes was lower in the group that received ESPB than the group that did not (WMD: -45.12; 95% CI: -68.82 to -21.43; P = 0.0002). Given the limited number of studies and the substantial heterogeneity of measured outcomes and interventions, further studies are required to assess the benefit of ESPB in midline sternotomies.


Assuntos
Bloqueio Nervoso , Dor Pós-Operatória , Músculos Paraespinais , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Músculos Paraespinais/inervação , Analgesia/métodos , Resultado do Tratamento , Assistência Perioperatória/métodos , Toracotomia/métodos
17.
Khirurgiia (Mosk) ; (7): 130-140, 2024.
Artigo em Russo | MEDLINE | ID: mdl-39008707

RESUMO

We demonstrated successful treatment of patients with complicated central lung cancer, who underwent right upper sleeve lobectomy with carinal resection. We have used the following options for carinal reconstruction: anastomosis of trachea with the left main bronchus and anastomosis of intermediate bronchus with the left main bronchus (clinical case No. 1) or with trachea (clinical case No. 2). Cervicothoracotomy provided correct N-staging and mobilization of trachea with left main bronchus. This approach provided compliance with oncological principles of surgical treatment of lung cancer and significantly reduced tension of anastomosis. These aspects are important for satisfactory immediate functional and oncological results after right upper sleeve lobectomy with carinal resection.


Assuntos
Brônquios , Neoplasias Pulmonares , Estadiamento de Neoplasias , Pneumonectomia , Toracotomia , Traqueia , Humanos , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Masculino , Traqueia/cirurgia , Toracotomia/métodos , Brônquios/cirurgia , Pessoa de Meia-Idade , Anastomose Cirúrgica/métodos , Resultado do Tratamento , Pulmão/cirurgia , Pulmão/diagnóstico por imagem , Feminino
18.
Innovations (Phila) ; 19(3): 298-305, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39066657

RESUMO

OBJECTIVE: While the benefits of minimally invasive aortic valve surgery compared with standard sternotomy have been widely described, the impact of preservation of pleural integrity (PPI) in minimally invasive surgery is still widely discussed. This study aims to define the role of PPI on postoperative and long-term outcomes after minimally invasive aortic valve replacement (MIAVR). METHODS: All 2,430 consecutive patients undergoing MIAVR (ministernotomy or right anterior minithoracotomy) between 1997 and 2022 were included in the study. Patients were divided into 2 groups: patients with and without PPI. PPI was considered the maintenance of the pleura closed without the need for a chest tube insertion at the end of the surgical procedure. A propensity-matched analysis was used to compare the PPI and not-PPI groups. RESULTS: After propensity matching, 848 patients were included in each group (PPI and not-PPI). The mean age was 70.21 versus 71.42 years, and the mean Society of Thoracic Surgeons predicted risk of mortality was 0.31% versus 0.30% in not-PPI versus PPI, respectively. The mean follow-up time was 147.4 months. Postoperatively, not-PPI versus PPI patients had a longer intensive care unit stay (9.7 vs 17.3 h, P < 0.001) and hospital length of stay (5.2 vs 8.9 days, P < 0.001). The rate of respiratory complications including the incidence of pneumothorax or subcutaneous emphysema, pulmonary atelectasis, and pleural effusion events requiring thoracentesis/drainage was significantly higher in not-PPI versus PPI. The 30-day all-cause mortality was higher in not-PPI versus PPI (0.029 vs 0.010, P = 0.003). Perioperative, short-term, and long-term all-cause mortality was significantly higher in the not-PPI group. CONCLUSIONS: PPI after MIAVR is associated with reduced incidence of postoperative complications, reduced lengths of stay, and improved overall survival compared with not-PPI. Therefore, a MIAVR tailored patient-procedure approach to maintaining the pleura integrity positively impacts short-term and long-term outcomes.


Assuntos
Valva Aórtica , Procedimentos Cirúrgicos Minimamente Invasivos , Pleura , Complicações Pós-Operatórias , Humanos , Masculino , Feminino , Idoso , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Valva Aórtica/cirurgia , Pleura/cirurgia , Complicações Pós-Operatórias/epidemiologia , Pessoa de Meia-Idade , Pontuação de Propensão , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Toracotomia/métodos , Toracotomia/efeitos adversos , Estudos Retrospectivos , Esternotomia/métodos , Esternotomia/efeitos adversos , Resultado do Tratamento , Tempo de Internação/estatística & dados numéricos , Idoso de 80 Anos ou mais
19.
Artigo em Inglês | MEDLINE | ID: mdl-38980286

RESUMO

This study elucidates the efficacy and outcomes of a minimally invasive aortic valve replacement via a right anterior mini-thoracotomy, emphasizing its potential to minimize surgical trauma and expedite recovery while maintaining procedural integrity comparable to that of a traditional full sternotomy. This video tutorial demonstrates a successful aortic valve replacement procedure using the right anterior mini-thoracotomy approach, characterized by the absence of sutureless valves and specialized instruments. The detailed surgical procedure includes specific steps to optimize visibility and access through strategic incisions and rib dislocations, adhering to "the box principle" for effective exposure of the aortic valve. This video tutorial suggests that a right anterior mini-thoracotomy is a viable, cost-effective alternative to a conventional sternotomy for aortic valve replacement, offering significant patient benefits without compromising long-term valve function or safety. The broader implications for patient selection and surgical techniques highlight the need for meticulous preoperative planning and anatomical assessment to maximize the potential of a right anterior mini-thoracotomy in clinical practice.


Assuntos
Valva Aórtica , Implante de Prótese de Valva Cardíaca , Procedimentos Cirúrgicos Minimamente Invasivos , Toracotomia , Humanos , Toracotomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Implante de Prótese de Valva Cardíaca/métodos , Valva Aórtica/cirurgia , Masculino , Feminino , Idoso , Esternotomia/métodos , Resultado do Tratamento , Estenose da Valva Aórtica/cirurgia
20.
J Cardiothorac Surg ; 19(1): 427, 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38982433

RESUMO

INTRODUCTION: Pulmonary regurgitation (PR) remains a common sequela in patients following surgically corrected TOF, and may lead to progressive right ventricle dilatation and dysfunction. The conventional approach of redo-sternotomy for pulmonary valve replacement (PVR) is associated with increased operative time as well as risks of bleeding and injury to the heart and great vessels. Thus, left anterior mini-thoracotomy has become an alternative approach in eliminating the risks of redo-sternotomy in these patients. This series aimed to determine the outcomes of minimally invasive pulmonary valve replacement after surgical TOF correction. METHODS: A retrospective analysis was conducted on 24 patients with severe PR post-surgical TOF correction who underwent left anterior mini-thoracotomy PVR in Penang General Hospital from January 2021 to January 2023. RESULTS: The median age was 23.5 years (I.Q.range 17.6-36.3), with a male:female ratio of 1:4. Majority of patients had mild to moderate symptoms prior to surgery and 19 patients (79.1%) were on regular diuretics medication. All patients had severe free-flow PR with evidence of right ventricular dilatation and dysfunction. Magnetic Resonance Imaging and computed tomography of pulmonary artery were performed prior to surgery. Minimally invasive PVR was performed on all patients via left upper anterior mini-thoracotomy and femoral-femoral bypass without cardioplegic arrest. The operative time and cardiopulmonary bypass time were 208 (I.Q.range 172-324) and 98.6 minutes(I.Q.range 87.4-152.4) respectively. The time to wean off inotropes postoperatively was 6.2 hours (I.Q.range1.4-14.8), and no postoperative arrhythmia and chest re-exploration were reported. Most patients stayed in Intensive Care Unit (ICU) for 10.8 hours (I.Q.range 8.4-36.5), and the total hospital stay was 4.2 days (I.Q.range 3.4-7.6). 2 patients (11.1%) required blood transfusion postoperative. There was no paravalvular leak and no mortality during the follow-up period of up to 28 months. CONCLUSION: Minimally invasive PVR after surgical correction of TOF is a safe alternative to the conventional redo-sternotomy approach in patients with favorable anatomy. This approach is able to reduce the risks associated with redo-sternotomy, particularly bleeding and injury to mediastinal structures, with the additional benefit of expedited recovery and hospital discharge. Our series has shown a safe and efficient approach in these patients with favorable outcomes.


Assuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Pulmonar , Tetralogia de Fallot , Toracotomia , Humanos , Masculino , Feminino , Tetralogia de Fallot/cirurgia , Estudos Retrospectivos , Adulto , Toracotomia/métodos , Adolescente , Implante de Prótese de Valva Cardíaca/métodos , Adulto Jovem , Insuficiência da Valva Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/etiologia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Pulmonar/cirurgia , Resultado do Tratamento
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