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1.
Thorac Cardiovasc Surg ; 64(4): 348-53, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25602850

RESUMO

Background Video-assisted thoracic surgery (VATS) for major lung resection has undergone major changes from three or four-port approach to the recently possible single-port VATS approach. Outcomes following single-port VATS major lung resection are analyzed to determine safety and efficacy. Methods A prospective database of 150 consecutive patients who underwent single-port VATS major lung resection between March 2012 and January 2014 was reviewed. Patient demographics, perioperative parameters, histopathology, and outcomes up to follow-up of 2 years were analyzed by descriptive and Kaplan-Meier survival statistics. Results Single-port VATS major lung resection was successfully performed in 142 patients (conversion rate 5.3%) for both malignant and benign diseases of the lung. Overall, 130 patients (87%) had nonsmall-cell lung carcinoma (NSCLC), 9 (6%) had other types of primary lung cancer, and the remaining for secondary malignancies and benign diseases. Among the 130 patients with NSCLC, 93 (71.5%) were stage I, 28 were stage II (21.5%), and 9 (7%) were stage III or greater. There was no intraoperative or 30-day mortality. However, one perioperative death occurred on day 49, and another on day 60 postoperatively due to infective causes. The overall 2-year mortality rate for all patients was 3%. The disease-free survival rate for subgroups, stage I NSCLC, and stage II or greater NSCLC were 96 and 83%, respectively. Conclusions Single-port VATS major lung resection for malignant and benign lung diseases is associated with low perioperative morbidity and mortality. Disease-free survival rates for NSCLC are acceptable and comparable with conventional VATS.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida , Idoso , Perda Sanguínea Cirúrgica , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Hong Kong , Hospitais Universitários , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Seul , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/mortalidade , Fatores de Tempo , Resultado do Tratamento
2.
ScientificWorldJournal ; 2012: 636754, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23024612

RESUMO

BACKGROUND: Angiogenic factors following oncological surgery is important in tumor recurrence. Vascular endothelial growth factor (VEGF), angiopoietin 1 (Ang-1), Ang-2, soluble VEGF-receptor 1 (sVEGFR1) and sVEGFR2 may influence angiogenesis. This prospective study examined the influence of open and video-assisted thoracic surgery (VATS) lung resections for early stage non-small cell lung cancer (NSCLC) on postoperative circulating angiogenic factors. METHODS: Forty-three consecutive patients underwent major lung resection through either VATS (n = 23) or Open thoracotomy (n = 20) over an 8-month period. Blood samples were collected preoperatively and postoperatively on days (POD) 1 and 3 for enzyme linked immunosorbent assay determination of angiogenic factors. RESULTS: Patient demographics were comparable. For all patients undergoing major lung resection, postoperative Ang-1 and sVEGFR2 levels were significantly decreased, while Ang-2 and sVEGFR1 levels markedly increased. No significant peri-operative changes in VEGF levels were observed. Compared with open group, VATS had significantly lower plasma levels of VEGF (VATS 170 ± 93 pg/mL; Open 486 ± 641 pg/mL; P = 0.04) and Ang-2 (VATS 2484 ± 1119 pg/mL; Open 3379 ± 1287 pg/mL; P = 0.026) on POD3. CONCLUSIONS: Major lung resection for early stage NSCLC leads to a pro-angiogenic status, with increased Ang-2 and decreased Ang-1 productions. VATS is associated with an attenuated angiogenic response with lower circulating VEGF and Ang-2 levels compared with open. Such differences in angiogenic factors may be important in lung cancer biology and recurrence following surgery.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Angiopoietina-1/sangue , Angiopoietina-2/sangue , Biomarcadores/sangue , Carcinoma Pulmonar de Células não Pequenas/irrigação sanguínea , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/irrigação sanguínea , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica , Estudos Prospectivos , Fator A de Crescimento do Endotélio Vascular/sangue , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/sangue
3.
Respirology ; 15(1): 6-18, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19947993

RESUMO

Minimally invasive thoracic surgery (MITS) has become part of the modern thoracic surgeon's armamentarium. Its applications include diagnostic and therapeutic procedures, and over the past one and a half decades, the scope of MITS has undergone rapid evolution. The role of MITS is well established in the management of pleural and mediastinal conditions, and it is beginning to move beyond diagnostic procedures for lung parenchyma conditions, to gain acceptance as a viable option for primary lung cancer treatment. However MITS poses technical challenges that are quite different from the conventional open surgical procedures. After a brief review of the history of MITS, an overview of the scope of MITS is given. Important examples of diagnostic and therapeutic indications are then discussed, with special emphasis on the potential complications specific to MITS, and their prevention and management.


Assuntos
Complicações Intraoperatórias/terapia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/terapia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Complicações Intraoperatórias/prevenção & controle , Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Dor Pós-Operatória/prevenção & controle , Pneumonectomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Ventilação Pulmonar , Cirurgia Torácica Vídeoassistida/métodos , Toracoscopia/efeitos adversos , Toracoscopia/métodos , Aderências Teciduais/prevenção & controle , Resultado do Tratamento
4.
Thorac Surg Clin ; 20(2): 297-309, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20451139

RESUMO

Videothoracoscopic approach to posterior mediastinal tumors is a safe operation in experienced hands. This approach produces results comparable to the other conventional surgical techniques for excision. This article describes the operative procedure and summarizes the advantages of this approach.


Assuntos
Neoplasias do Mediastino/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Anestesia Geral , Contraindicações , Ganglioneuroma/diagnóstico por imagem , Ganglioneuroma/cirurgia , Humanos , Intubação Intratraqueal , Laminectomia , Imageamento por Ressonância Magnética , Neoplasias do Mediastino/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
Surgeon ; 8(5): 280-6, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20709286

RESUMO

Minimal invasive video-assisted thoracic surgery can be a safe alternative technique in the assessment, diagnosis and surgical resection of posterior mediastinal tumours. Video-assisted thoracic surgery may be particularly suited for the management of posterior mediastinal tumours as most are benign. Surgical technique continues to evolve from the classic 3-port access in order to tackle more complex tumours positioned at the apical and inferior recesses of the posterior mediastinum. The preoperative identification of dumbbell tumours is important to facilitate arrangements for a single-stage combined resection for both the intra-thoracic and intraspinal tumour. Results from Video-assisted thoracic surgery posterior mediastinal tumour resection are comparable with conventional surgical techniques in terms of symptomatic improvement, recurrence and survival. Video-assisted thoracic surgery approach has been shown to result in less post-operative pain, improved cosmesis, shorter hospital stay, and more rapid recovery and return to normal activities. In over a decade, video-assisted thoracic surgery has gradually matured and is now a promising therapeutic alternative to open approach. In certain selected patients, video-assisted thoracic surgery may be considered the standard of care for conditions of the posterior mediastinum. Recent developments in robotic surgery for the management of mediastinal tumours are promising, however, long-term results are pending.


Assuntos
Neoplasias do Mediastino/cirurgia , Cirurgia Torácica Vídeoassistida , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Robótica , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Curr Vasc Pharmacol ; 5(1): 85-92, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17266616

RESUMO

Although nitric oxide (NO) is recognized as the primary vasodilator derived from vascular endothelium in regulating the vascular tone, another factor, i.e. the endothelium-derived hyperpolarizing factor (EDHF), has recently gained much attention and has been demonstrated to participate in vasodilatation in various blood vessels from different species, despite its unidentified nature. Most of the studies were conducted in animals and the knowledge of this factor in the human vasculature is relatively limited. This review attempts to address the relevance of EDHF-mediated function in humans with the possible identity of EDHF and mechanisms involved. We consider the human vasculature where EDHF involvement has been documented including the systemic, coronary, and visceral (gastrointestinal, renal and reproductive) circulation. In these vascular systems, EDHF plays a role under physiological conditions either as another mechanism or as the "back-up" for NO. Furthermore, the contribution of EDHF changes under certain physiological conditions, such as ageing and pregnancy. In addition, altered EDHF function has been suggested in various pathological conditions including heart diseases, atherosclerosis, hypertension, diabetes, eclampsia, glaucoma, chronic renal failure, erectile dysfunction and ischemia-reperfusion period during open heart surgery. Pharmacological agents such as potassium channel openers or cytochrome P450 metabolites have been used to either protect or recover EDHF-dependent mechanisms. To further develop new therapeutic strategies that target EDHF, a better understanding is essential with regard to the function of EDHF under pathophysiological conditions in humans. Furthermore, the interaction between NO and EDHF as well as their relative contributions in various conditions are critical.


Assuntos
Fatores Biológicos/fisiologia , Circulação Sanguínea/fisiologia , Animais , Vasos Sanguíneos/fisiologia , Vasos Sanguíneos/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Humanos , Vasodilatação/fisiologia
8.
Vascul Pharmacol ; 46(4): 253-9, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17174609

RESUMO

OBJECTIVES: Due to potential therapeutic value of vascular endothelial growth factor (VEGF) in coronary artery disease, the effect and mechanism of VEGF in human arteries used as coronary bypass grafts become important but not fully understood. VEGF-mediated endothelial regulation in vasorelaxation was studied in internal mammary artery (IMA) and radial artery (RA), compared with that of the classical agent-acetylcholine (ACh). The role of nitric oxide (NO), prostacyclin (PGI2), and endothelium-derived hyperpolarizing factor (EDHF) was investigated. METHODS: VEGF- and ACh-induced responses were measured in RA and IMA with or without endothelium and in the absence or presence of inhibitors of nitric oxide synthase or prostacyclin. In addition, the VEGF-induced PGI2 was measured by enzyme immunoassay. RESULTS: VEGF induced similar relaxation in RA (59.2+/-9.3%) and IMA (56.1+/-6.4%) that was significantly inhibited by N(omega)-nitro-L-arginine (L-NNA) plus oxyhemoglobin (HbO) (IMA: 24.9+/-4.3%, P=0.03 vs. RA: 25.0+/-8.6%, P=0.01) or by indomethacin (INDO) (IMA: 21.8+/-2.5%, P=0.000 vs. RA: 30.0+/-6.6%, P=0.04) with more inhibition in IMA than RA (P<0.05). In addition, the VEGF-induced PGI2 was significantly higher in IMA than RA (11.5+/-2.1 vs. 4.9+/-1.1 pg/ml/mg, P=0.002). INDO+L-NNA+HbO reduced the VEGF-induced relaxation to 20.8+/-4.6% in RA vs. 4.8+/-1.6% in IMA (P=0.01). In contrast, the maximal relaxation induced by ACh in RA (55.9+/-6.0%) and IMA (48.5+/-5.3%) was largely inhibited by L-NNA in IMA and RA (14.7+/-3.0%, P=0.000 vs. 15.2+/-3.2%, P=0.004) but little affected by INDO. CONCLUSIONS: VEGF induces similar relaxation in IMA and RA with significantly more PGI2-mediated relaxation and higher stimulated PGI2 level in IMA but more EDHF-mediated relaxation in RA. In comparison, ACh-induced relaxation mainly depends on NO. Thus, our study reveals a significant difference in the mechanism of the endothelium-dependent relaxation induced by VEGF and ACh.


Assuntos
Artéria Torácica Interna/efeitos dos fármacos , Artéria Radial/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/farmacologia , Vasodilatação/efeitos dos fármacos , Vasodilatadores/farmacologia , Ácido 15-Hidroxi-11 alfa,9 alfa-(epoximetano)prosta-5,13-dienoico/farmacologia , Acetilcolina/farmacologia , Fatores Biológicos/metabolismo , Inibidores de Ciclo-Oxigenase/farmacologia , Relação Dose-Resposta a Droga , Inibidores Enzimáticos/farmacologia , Epoprostenol/metabolismo , Sequestradores de Radicais Livres/farmacologia , Humanos , Técnicas In Vitro , Indometacina/farmacologia , Artéria Torácica Interna/metabolismo , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase/antagonistas & inibidores , Nitroarginina/farmacologia , Oxiemoglobinas/farmacologia , Artéria Radial/metabolismo , Vasoconstritores/farmacologia
9.
Eur J Cardiothorac Surg ; 31(1): 103-8, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17095239

RESUMO

OBJECTIVE: Studies in other surgical specialties have suggested that pre-emptive wound infiltration using a local anesthetic may reduce post-operative pain. We report the first randomized trial to assess the use of pre-emptive local anesthesia in video-assisted thoracic surgery (VATS). METHOD: Thirty-one consecutive patients undergoing bilateral needlescopic VATS sympathectomy for palmar hyperhidrosis were studied prospectively. Each patient acted as their own control. For each patient, one side was randomized to receive 10ml 0.5% bupivicaine injected to the port sites before incision, and the contralateral control side to receive 10ml saline. Pain severity on a visual analog scale (VAS) was recorded for each chest side at 4h, 1 day and 7 days following surgery. All patients were blinded to the results of randomization throughout the study. RESULTS: Follow up was complete for all patients. At 7 days after surgery, wound pain was significantly reduced by pre-emptive local anesthesia, with 10 (62.5%) of the 16 patients having residual pain reporting less pain on the pre-treated side (p=0.039). There was a trend for reduced pain on the pre-treated side at the other time points. Pain reduction by pre-emptive local anesthesia was not correlated with any demographic or clinical variable. Chest wall paresthesia distinct from localized wound pain was noted by six patients (19.4%), but was not reduced by pre-emptive local anesthesia. Overall, the post-operative discomforts felt by the patients after needlescopic VATS were mild, and did not cause significant functional disturbances. CONCLUSION: Pre-emptive wound infiltration with a local anesthetic may reduce post-operative wound pain in needlescopic VATS procedures.


Assuntos
Anestesia Local/métodos , Dor Pós-Operatória/prevenção & controle , Cirurgia Torácica Vídeoassistida , Adolescente , Adulto , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Hiperidrose/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Parestesia/prevenção & controle , Satisfação do Paciente , Estudos Prospectivos , Método Simples-Cego , Simpatectomia/métodos
10.
Eur J Cardiothorac Surg ; 31(1): 83-7, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17118669

RESUMO

OBJECTIVE: Major surgery is immunosuppressive and could have an impact on postoperative tumor immunosurveillance and recurrence in cancer patients. Low circulating levels of insulin growth factor binding protein (IGFBP)-3 have been linked to advance prostate and the development of colonic cancers. This prospective study examined the early postoperative circulating levels of IGFBP-3, matrix metalloproteinase (MMP)-9, and tissue inhibitor of metalloproteinase (TIMP)-1 in early stage non-small cell lung cancer (NSCLC) patients undergoing major lung resection by VATS versus thoracotomy. METHODS: Forty-two consecutive patients with resectable primary NSCLC were assigned to VATS or thoracotomy approach over a 7-month-period. Blood samples were collected preoperatively and postoperatively on days (POD) 1 and 3 for enzyme linked immunosorbent assay determination of IGFBP-3, MMP-9 and TIMP-1 levels in the serum. RESULTS: There were no demographic differences between the two groups. VATS lung resection was associated with lower levels of MMP-9 and TIMP-1 on POD1 (median 628 vs 1311ng/ml, p=0.009; and 131 vs 211ng/ml, p=0.004, respectively) but higher levels of IGFBP-3 on POD3 (1366 vs 1144ng/ml, p=0.02), when compared with the thoracotomy approach. There was no perioperative mortality. CONCLUSIONS: VATS major lung resection for NSCLC is associated with higher circulating levels of IGFBP-3, and lower levels of MMP-9 and TIMP-1, compared to the thoracotomy approach. The clinical relevance of these postoperative changes on tumor biology following lung resection for cancer warrants further investigation.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Quimiocinas/sangue , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida , Idoso , Biomarcadores/sangue , Carcinoma Pulmonar de Células não Pequenas/imunologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina , Proteínas de Ligação a Fator de Crescimento Semelhante a Insulina/sangue , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/patologia , Masculino , Metaloproteinase 9 da Matriz/sangue , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pós-Operatório , Estudos Prospectivos , Inibidor Tecidual de Metaloproteinase-1/sangue
11.
Thorac Surg Clin ; 17(2): 233-9, ix, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17626401

RESUMO

Recent advances in imaging, chemical pathology, and target therapy have made it necessary to redefine the role of surgery in the therapeutic algorithm in the management of lung cancer. Although video-assisted thoracic surgery lobectomy with hilar and mediastinal lymph node dissection was proposed over a decade ago to treat early lung cancer, this technique is currently not widely practiced, despite many documented advantages. This article examines the role of video-assisted thoracic surgery lobectomy in the treatment of early lung cancer and, in particular, variations in the approach and published results.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Carcinoma Pulmonar de Células não Pequenas/patologia , Ensaios Clínicos como Assunto , Humanos , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Pneumonectomia/estatística & dados numéricos , Complicações Pós-Operatórias , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos
13.
Cancer Lett ; 234(2): 193-8, 2006 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-15876485

RESUMO

There is little information regarding simultaneous investigations of thromboxane A(2) (TXA(2)) lipid peroxidation and Bcl-2, three cancer-related agents, and analyses of their relationships in lung cancer. The present study was to study thromboxane B(2) (TXB(2)), a stable metabolite of TXA(2), lipid peroxidation and Bcl-2 expression in 52 non-small cell lung carcinoma (NSCLC) tissue samples. The level of thiobarbituric acid reactive substances (TBARS), an index for lipid peroxidation was significantly increased in the lung tumor tissues, compared with non-tumor tissues. TXB(2) was much higher in the tumor tissues than non-tumor tissues. Interestingly, the concentration of TXB(2) in samples from those who smoked was higher than that from those who did not smoke. The expression of Bcl-2 was significantly elevated in the tumor tissues, compared to the non-tumor tissues. There was also a positive correlation between TXB(2) and TBARS in tumor tissues; advanced stage cancers had higher levels of TXB(2). This finding supports the idea that TXB(2) may have a role in promoting tumor growth. In conclusion, our study demonstrates that the production of TXB(2) is increased in lung tumor tissues and that such an increase can result in lipid peroxidation which may be met by an elevation in Bcl-2 expression.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/metabolismo , Peroxidação de Lipídeos/fisiologia , Neoplasias Pulmonares/metabolismo , Proteínas Proto-Oncogênicas c-bcl-2/biossíntese , Tromboxano B2/metabolismo , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Substâncias Reativas com Ácido Tiobarbitúrico/análise
14.
Chest ; 129(3): 518-26, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16537847

RESUMO

OBJECTIVES: To report the first multicenter experience on the treatment of end-stage emphysema using an endobronchial valve (EBV) [Emphasys EBV; Emphasys Medical; Redwood City, CA]. DESIGN: Retrospective analysis from prospective multicenter registry. PATIENTS AND INTERVENTIONS: This is a study of the use of EBVs in the treatment of end-stage emphysema at nine centers in seven countries. Ninety-eight patients with mean FEV(1) of 0.9 +/- 0.3 L (30.1 +/- 10.7% of predicted) [+/- SD] and residual volume (RV) of 5.1 +/- 1.3 L (244.3 +/- 0.3% of predicted) were treated over a period of 20 months. Spirometry, plethysmography, and diffusing capacity of the lung for carbon monoxide (Dlco) and exercise tolerance testing were performed at 30 days and 90 days after the procedure. RESULTS: RV decreased by 4.9 +/- 17.4% (p = 0.025), FEV(1) increased by 10.7 +/- 26.2% (p = 0.007), FVC increased by 9.0 +/- 23.9% (p = 0.024), and 6-min walk distance increased by 23.0 + 55.3% (p = 0.001). There was a trend toward improvement in Dlco, but this did not reach statistical significance (17.2 +/- 52.0%, p = 0.063). Patients treated unilaterally showed a trend toward greater improvement than those treated bilaterally. A similar trend toward improvement was observed in patients who had one entire lobe treated compared to those with just one or two bronchopulmonary segments treated. Eight patients (8.2%) had serious complications in the first 90 days, including one death (1.0%). CONCLUSION: This multicenter analysis confirms that improvement in pulmonary function and exercise tolerance can be achieved in emphysematous patients using EBVs. Future efforts should be directed to determining how to select those patients who would benefit most from this procedure and the best endobronchial treatment strategy.


Assuntos
Broncoscopia , Pneumonectomia/métodos , Enfisema Pulmonar/cirurgia , Idoso , Tolerância ao Exercício , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Pneumonectomia/instrumentação , Capacidade de Difusão Pulmonar , Enfisema Pulmonar/fisiopatologia , Estudos Retrospectivos , Capacidade Vital
16.
Vascul Pharmacol ; 44(3): 183-91, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16448859

RESUMO

OBJECTIVE: To compare electrophysiological measurement of nitric oxide (NO) release and endothelium-derived hyperpolarizing factor (EDHF)-mediated endothelial function in porcine pulmonary arteries and veins. METHODS: Isolated pulmonary interlobular arteries (PA) and veins (PV) were obtained from a local slaughterhouse. By using a NO-specific electrode and a conventional intracellular microelectrode, the amount of NO released from endothelial cells and hyperpolarization of smooth muscle cells were investigated. The bradykinin (BK)-induced relaxation in the precontraction by U(46619) was examined in the absence or presence of N(G)-nitro-l-arginine (l-NNA), indomethacin (INDO) plus oxyhemoglobin (HbO). RESULTS: The basal release of NO was 7.0+/-1.2 nmol/L in PA (n=8) and 5.5+/-1.6 nmol/L in PV (n=8, p<0.01). BK-induced release of NO was 160.4+/-10.3 nmol/L in PA (n=8) and 103.0+/-14.7 nmol/L in PV (n=8, p<0.001) with longer releasing duration in PA than in PV (14.3+/-1.3 vs. 12.1+/-0.8 min, p<0.01). BK evoked an endothelium-dependent hyperpolarization and relaxation that were reduced by l-NNA, INDO, and HbO (hyperpolarization: 12.8+/-1.3 vs. 8.0+/-1.4 mV in PA, n=6, p<0.001 and 8.3+/-1.4 vs. 3.0+/-0.8 mV in PV, n=6, p<0.001; relaxation: 92.8+/-3.1% vs. 19.6+/-11.1% in PA n=8, p<0.001 and 70.3+/-7.9% vs. 6.0+/-6.8% in PV, n=8, p<0.001). Both hyperpolarization (8.0+/-1.4 vs. 3.0+/-0.8 mV, p<0.001) and relaxation (19.6+/-11.1% vs. 6.0+/-6.8%, p<0.01) were greater in PA than in PV. CONCLUSIONS: Both NO and EDHF play an important role in regulation of porcine pulmonary arterial and venous tones. The more significant role of NO and EDHF is revealed in pulmonary arteries than in veins.


Assuntos
Fatores Biológicos/metabolismo , Músculo Liso Vascular/fisiologia , Óxido Nítrico/metabolismo , Artéria Pulmonar/metabolismo , Veias Pulmonares/metabolismo , Vasodilatação , Animais , Bradicinina/farmacologia , Relação Dose-Resposta a Droga , Técnicas In Vitro , Potenciais da Membrana , Músculo Liso Vascular/efeitos dos fármacos , Artéria Pulmonar/efeitos dos fármacos , Veias Pulmonares/efeitos dos fármacos , Suínos , Fatores de Tempo , Vasodilatadores/farmacologia
17.
Eur J Cardiothorac Surg ; 29(5): 795-9, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16581258

RESUMO

OBJECTIVE: The pain following thoracic surgery and trauma is often refractory to conventional analgesic strategies. However, it shares key characteristics with neuropathic pain which gabapentin, an anticonvulsant, has been proven to effectively treat. To our knowledge, this is the first prospective study assessing the use of gabapentin in cardiothoracic surgery patients. METHODS: Gabapentin was prescribed to 60 consecutive out-patients with refractory pain persisting at four weeks or more after thoracic surgery or trauma. Follow-up of 45 patients (75%) was performed for a median of 21 months (range: 12-28), and clinical data collected prospectively. The mean age of these patients was 51.6 years (range 22-83). Of these 45 patients, 22 had received video-assisted thoracic surgery (VATS), 8 had received thoracotomy, 3 had received median sternotomy, and 12 were treated for blunt chest trauma. RESULTS: The mean duration of pre-treatment refractory pain was 5.76 months (range 1-62). The mean duration of gabapentin use was 21.9 weeks (range 1-68). No deaths or major complications were encountered. Minor side effects-mostly somnolence and dizziness-occurred in 18 patients (40.0%), causing 3 patients (6.7%) to discontinue gabapentin. Overall, 33 patients (73.3%) noted reduction of pain. Chest wall paresthesia distinguishable from wound pain was relieved in 24 (75.0%) of 32 affected patients. Severe initial pain was significantly correlated with pain relief using gabapentin (p=0.009). No other demographical or clinical variable correlated with benefit or side effects. Satisfaction with gabapentin use was expressed by 40 patients (88.9%). Side effects were not a source of dissatisfaction in any patient. CONCLUSIONS: Gabapentin appears safe and well tolerated when used for persistent post-operative and post-traumatic pain in thoracic surgery patients, although minor side effects do occur. Gabapentin may relieve refractory chest wall pain in some of these patients, particularly those with more severe pain. Further studies are warranted to define the role of gabapentin in cardiothoracic surgical practice.


Assuntos
Aminas , Analgésicos , Ácidos Cicloexanocarboxílicos , Dor Intratável/tratamento farmacológico , Traumatismos Torácicos/complicações , Toracotomia , Ácido gama-Aminobutírico , Adulto , Idoso , Idoso de 80 Anos ou mais , Aminas/efeitos adversos , Analgésicos/efeitos adversos , Ácidos Cicloexanocarboxílicos/efeitos adversos , Feminino , Gabapentina , Humanos , Masculino , Pessoa de Meia-Idade , Dor Intratável/etiologia , Dor Pós-Operatória/tratamento farmacológico , Parestesia/tratamento farmacológico , Parestesia/etiologia , Satisfação do Paciente , Estudos Prospectivos , Cirurgia Torácica Vídeoassistida , Resultado do Tratamento , Ferimentos não Penetrantes/complicações , Ácido gama-Aminobutírico/efeitos adversos
18.
Eur J Cardiothorac Surg ; 29(5): 742-6; discussion 747, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16581260

RESUMO

OBJECTIVE: Neointimal and medial thickening play a critical role in late vein graft failure following CABG. Previous ex vivo experiment suggested that perivenous application of fibrin glue may reduce the damage in the circular smooth muscle cell layer of the media of the vein graft shortly after exposing to arterial pressure. However, the in vivo as well as the longer term impact of this intervention remain unknown. METHODS: Bilateral saphenous vein-carotid artery interposition grafting was performed in eight large white pigs (35-45 kg). In each pig, one of the grafts was randomly selected to receive perivenous fibrin glue support while the contralateral graft served as control. At 1 and 4 months following surgery (n=4 pigs in each group), all 16 patent vein grafts were removed and pressure-fixed. Multiple histological sections from each graft were prepared. Proliferating cell nuclear antigen (PCNA) was detected by immunocytochemistry. Vein graft morphology was assessed using computer-aided planimetry. RESULTS: Although perivenous application of fibrin glue had little effects either on medial thickness 1 month after implantation or on PCNA index, it significantly increased medial thickness (control: 0.37+/-0.02 mm; treated: 0.55+/-0.02 mm, p<0.001) and total wall thickness (control: 0.75+/-0.04 mm; treated: 0.92+/-0.04 mm, p=0.008) at 4 months (mean+/-SEM; n=4 in each group). CONCLUSIONS: Our data indicated that perivenous application of fibrin glue enhances graft thickening and as such does not constitute a strategy for preventing late vein graft failure after CABG.


Assuntos
Ponte de Artéria Coronária/métodos , Adesivo Tecidual de Fibrina/farmacologia , Veia Safena/transplante , Adesivos Teciduais/farmacologia , Túnica Média/efeitos dos fármacos , Anastomose Cirúrgica/métodos , Animais , Artérias Carótidas/transplante , Proliferação de Células/efeitos dos fármacos , Modelos Animais de Doenças , Rejeição de Enxerto/prevenção & controle , Período Pós-Operatório , Antígeno Nuclear de Célula em Proliferação/metabolismo , Veia Safena/patologia , Suínos , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/patologia , Túnica Média/patologia , Grau de Desobstrução Vascular
19.
Can Respir J ; 13(4): 219-21, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16779468

RESUMO

The present report describes a case of severe airway obstruction caused by endobronchial tuberculosis in an 11-year-old girl who was successfully treated by bronchoscopic balloon dilation. This case illustrates the insidious presentation and the increasingly important role of bronchoscopic intervention in the management of endobronchial tuberculosis. In addition, a brief literature review of the condition in the pediatric age group is included.


Assuntos
Broncopatias/terapia , Broncoscopia , Tuberculose/terapia , Criança , Feminino , Humanos
20.
Ann Thorac Cardiovasc Surg ; 12(5): 308-12, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17095971

RESUMO

The development of video-assisted thoracic surgery (VATS) in the past decade has changed the way many pulmonary conditions are being treated. VATS has gained popularity among clinicians due to faster recovery following surgery, less postoperative pain and better cosmesis. It is well known that surgical trauma can induce a systemic inflammatory response and affect postoperative systemic immunity. Minimal access VATS has been shown to be associated with a reduced postoperative systemic inflammatory response. Recent evidence suggests VATS is also associated with better cellular immunity, and produces less immunochemokine disturbance following surgery, when compared with the thoracotomy approach. Circulating natural killer (NK) cell numbers and levels of insulin growth factor binding protein (IGFBP) are found to be higher, and plasma levels of matrix metalloproteinases are lower following VATS than that after thoracotomy. Maintenance of immune function with VATS may have important clinical implications in lung cancer surgery.


Assuntos
Imunidade Celular , Neoplasias Pulmonares , Cirurgia Torácica Vídeoassistida/métodos , Seguimentos , Humanos , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
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