RESUMO
Because the esophagus is a tubular muscular structure only partially filled with air and surrounded by major structures (vessels, lungs, and heart), its radiologic evaluation cannot be performed solely by conventional chest radiograph or barium studies. The emergence of newer techniques has had a dramatic effect on the use of luminal contrast examinations of the gastrointestinal tract. This article describes the current radiographic techniques for examining the gastrointestinal tract with contrast materials, emphasizing the role of barium suspensions, computed tomography scan, and magnetic resonance imaging, and illustrating normal anatomy.
Assuntos
Esôfago/anatomia & histologia , Esôfago/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
Diseases of the mediastinum comprise a wide spectrum of benign and malignant entities that share the same anatomic site within the chest. Correct management often requires a multidisciplinary approach. Diagnostic imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, and positron emission tomography play a major role in the diagnosis of mediastinal diseases and in guiding minimally invasive diagnostic procedures, minimizing the risk of imaging-guided biopsies. This article describes the mediastinal anatomy, correlating the findings of plain radiography, CT, and MRI.
Assuntos
Mediastino/anatomia & histologia , Veia Ázigos/anatomia & histologia , Esôfago/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Mediastino/diagnóstico por imagem , Timo/anatomia & histologia , Timo/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To evaluate the contribution that unilateral thoracic sympathectomy in dominant side or two-stage bilateral thoracic sympathectomy can have as strategies to reduce the incidence of compensatory sweating after sympathectomy for palmar hyperhidrosis. METHODS: This is a prospective, controlled, randomized multicenter trial of 200 participants with palmar hyperhidrosis, which will be randomized into two arms: (a) one-stage bilateral thoracic sympathectomy (control arm); or (b) unilateral thoracic sympathectomy in dominant side (intervention arm). At six months the participants submitted to unilateral procedure can make the contralateral surgery if they wanted it, creating a third group called two-stage bilateral sympathectomy. Participants will be evaluated for the degree of sweating by the Hyperhidrosis Disease Severity Scale (HDSS) and of quality of life questionnaires. RESULTS: 96 participants out of the 200 proposed have been included so far, with 48 participants randomized to each arm. From the sample 61 (63.5%) are female, with a mean age of 24 (20-32) years. There were exclusive palmar hiperhydrosis in 14 cases (14.5%), palmar and plantar hyperhidrosis in 36 (37.5%) cases, palmar and axillar hyperhidrosis in 12 (12,5%) cases and palmar-axillary-plantar hyperhidrosis in 34 (35,4%) cases. The age at the beginning of the disease was childhood (78%), with mean of time of disease 15 (11-22) years. CONCLUSIONS: If one or both hypothesis: (a) unilateral sympathectomy in dominant hand is a satisfactory treatment; b) two-stage bilateral sympathectomy causes less compensatory sweating than in one stage are confirmed there is a chance that surgical therapy for palmar hyperhidrosis can be changed for better.
RESUMO
OBJECTIVES: Minimally invasive thoracic procedures have been increasingly used; however, only a small number of lobectomies are performed by videothoracoscopy, showing the need for training on this technique. The objective of this study is to demonstrate the technique of lobectomy using videothoracoscopy in swine, highlighting the steps to be taken during its use in surgical experimentation. METHODS: During the advanced course on video-assisted and thoracoscopic procedures carried out at IRCAD Latin America, Barretos, Brazil, 40 swine were used for the hands-on course on video-assisted upper left lobectomy. Monopulmonary ventilation was performed by blocking the left main bronchus. Surgical procedures were performed using three ports and the anterior dissection technique (fissureless approach). The pulmonary hilar structures were dissected using conventional open surgery and video-assisted surgical tools. The first structure treated in the approach of the hilar structures was the upper lobe vein, followed by the bronchus and the branches of the pulmonary artery. RESULTS: The mean time required to anaesthetize the animals was 3 h. Intraoperative hypoventilation was observed in 26 animals (65%) and 4 (10%) of them had a poor outcome and died in the last third part of the surgery. Eight (20%) animals had bradycardia, and six responded to the use of atropine. In two (5%), it was not possible to revert the bradycardia and the animals died at the end of the procedures. The surgical procedures had a mean duration of 3 h and the total time of anaesthesia was about 6 h. DISCUSSION: Swine have been frequently used for hands-on training in surgery but there are no reports in the literature describing the anatomical, anaesthetic and technical peculiarities that must be observed during videothoracoscopic lobectomy training in swine. Video-assisted thoracoscopic surgery lobectomy using swine is an adequate method to train thoracic surgeons. For surgeons to make the best use of minimally invasive technique training, it is essential that issues related to the anatomy, anaesthesia, monopulmonary ventilation and surgical technique described in this study are taken into account.
Assuntos
Pneumonectomia/educação , Cirurgia Torácica Vídeoassistida/educação , Animais , Modelos Animais , Pneumonectomia/métodos , Suínos , Cirurgia Torácica Vídeoassistida/métodosRESUMO
OBJECTIVES: This study is aimed at drawing the profile of the Brazilian general thoracic surgeon. This experience has been fruitful in other areas, helping attract manpower and to better serve the interests of other Societies. This is the first survey of this kind in Brazil and in Latin America. METHODS: An electronic invitation was sent to the members of the Brazilian Society of Thoracic Surgery to answer a web-based questionnaire and physicians potentially practising thoracic surgery, with 82 questions including demographic data, medical education, training in general and thoracic surgery, continued professional education, practice profile, research activities and certifications, participation in medical societies, income/compensation and career satisfaction. Quantitative and qualitative analyses are presented. RESULTS: The estimated level of participation was 82% (468). The mean age of the active general thoracic surgeon is 43.2 (range 45.3±11.4) years. Women comprised 8% (37) of respondents, and 60% (277) of the participants had graduated from public medical schools. Four states nationwide trained 88% (391) of the thoracic surgeons. Only 32% (149) of the surgeons work exclusively with thoracic surgery. The public health system is the main provider of income for thoracic surgeons. Only 11 of 27 states have an adequate, although poorly distributed, number of thoracic surgeons. CONCLUSIONS: Although Brazil has a reasonable number of general thoracic surgeons, inequalities in their distribution through the country arise as one of the most concerning problems of the speciality. The results of this study show that leadership actions and consistent government policies are required to improve work conditions and provide efficient workforce planning.
Assuntos
Cirurgia Torácica , Adulto , Brasil , Feminino , Humanos , Renda/estatística & dados numéricos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Cirurgia Torácica/educação , Cirurgia Torácica/estatística & dados numéricos , Recursos HumanosRESUMO
Na ultima década, os avanços tecnológicos e o desenvolvimento de novas técnicas têm nos apresentado novas alternativas na abordagem mediastinal dos pacientes com neoplasia pulmonar, que vão desde os métodos de imagem metabólicos; como a tomografia com emissão de pósitrons, passando pela ecografia endoscópica até as técnicas cirúrgicas mais abrangentes de linfadenectomia mediastinal por via transcervical que tentam suplantar a já bem estabelecida mediastinoscopia cervical. Durante este tempo, vários artigos vêm sendo publicados, provendo um substancial corpo de evidência em relação aos diferentes aspectos destas técnicas. Baseado nestas evidências, vamos discutir um pouco da técnica, das aplicações e dos resultados das novas técnicas cirúrgicas de estadiamento mediastinal, a linfadenectomia mediastinal vídeo-assistida (VAMLA) e a linfadenectomia trascervical estendida (TEMLA).
Assuntos
Humanos , Masculino , Feminino , Excisão de Linfonodo , Mediastino , Estadiamento de Neoplasias , Procedimentos Cirúrgicos TorácicosRESUMO
Carcinosarcomas de pulmäo säo neoplasias raras que recorrem em posiçäo endobrônquica e perifericamente no parênquima pulmonar. Histologicamente diferenciam-se dos blastomas, podendo no entanto existir formas transicionais entre ambos. Dois novos casos dessa entidade säo relatados. É abordada com maior ênfase a caracterizaçäo histopatológica dos elementos epiteliais e mesenquimais e seus aspectos imuno-histoquímicos. Com esse objetivo, foram usados anticorpos policlonais, como citoqueratina, antígeno carcinoembrionário, vimentina, enolase neuro-específica, proteína S-100 e p anticorpo HHF35, dirigido para actina músculo-específica. No primeiro caso o componente epitelial se caracterizou pela diferenciaçäo epidermóide e de adenocarcinoma, incluindo áreas com padräo tipo carcinoma bronquíolo-alveolar. Este último aspecto esteve presente em um único caso daqueles descritos anteriormente. A imuno-histoquímica demonstrou positividade para citoqueratina nos diversos componentes epiteliais. O elemento mesenquimal expressou vimentina e actina músculo-específica. O segundo caso exibiu o componente epitelial com diferenciaçäo neuroenócrina, traduzida no estudo histológico convencional por carinoma anaplásico de pequenas células; a imuno-histoquímica mostrou positividade acentuada para a enolase neuro-especifica, um marcador neuroendócrino bem conhecido. Algumas células do componente sarcomatoso também mostraram-se positivas com esse marcador. A vimentina corou exclusivamente as células mesenquimais. A diferenciaçäo do tipo carcinoma de pequenas células correlaciona-se com a curta sobrevida do paciente, mesmo com todas as tentativas terapêuticas efetuadas. Esse tipo de diferenciaçäo do elemento epitelial foi poucas vezes observado nos casos relatados, e a maioria dos autores, classificando as lesöes como carcinomas anaplásicos, näo fazem distinçäo entre aqueles de grandes e pequenas células