RESUMO
A 74-year-old male patient was referred with signs of sepsis 5 days after having been diagnosed with a rib fracture following a fall out of bed. Novel hypodensities were visible on thoracic Xrays and laboratory tests revealed elevated inflammatory parameters. Subsequently performed thoracic computed tomography (CT) scan showed burst fracture of the 3rd thoracic vertebra, posttraumatic esophageal rupture at the same level and mediastinitis. Furthermore, marked degenerative changes of the spinal column (diffuse idiopathic skeletal hyperostosis) were present. The patient underwent emergency thoracotomy and esophagectomy. Gastric pull-up with esophagogastrostomy was postponed for 3 days. After 14 days on the intensive care unit (ICU) and 12 days of i.v. antibiotics, the patient was transferred to the general ward and 7 weeks after trauma the patient was infection-free without difficulties in swallowing. Up to the latest follow-up 41 months following injury, several endoscopic dilations with a bougie due to constrictions at the anastomosis have been performed. Similar to previous cases in the literature, esophageal injury was diagnosed delayed, with the patient already having developed severe complications. This extremely seldom injury should be suspected in young patients following high-energy trauma, but also in older patients after low-energy trauma but known degenerative changes of the vertebral column.
RESUMO
(1) Background: Long COVID syndrome (LCS) is a heterogeneous long-standing condition following COVID-19 infection. Treatment options are limited to symptomatic measures, and no specific medication has been established. Hyperbaric oxygenation (HBO) has been found to have a positive impact on the treatment of COVID-19 infection. This study evaluates both the feasibility and outcome of supportive HBO in patients with LCS. (2) Methods: Within 17 months, 70 patients with proven LCS were prospectively included. Each patient underwent a cycle of 10 subsequent HBO treatment sessions administered for 75 min at 2.2 atmospheres. Evaluation of the patients was performed before the first and after the last HBO session and 3 months afterwards. Statistical evaluation was based on an intention-to-treat analysis using Fisher's exact test and Student's t-test for paired samples. (3) Results: In total, 59 patients (33 females, 26 males; mean age: 43.9 years; range: 23-74 years; median: 45.0) were evaluable. After HBO, a statistically significant improvement of physical functioning (p < 0.001), physical role (p = 0.01), energy (p < 0.001), emotional well-being (p < 0.001), social functioning (p < 0.001), pain (p = 0.01) and reduced limitation of activities (p < 0.001) was confirmed. (4) Conclusions: Physical functioning and both the physical and emotional role improved significantly and sustainably, suggesting HBO as a promising supportive therapeutic tool for the treatment of LCS.
RESUMO
BACKGROUND: Early diagnosis of anastomotic dehiscence following cervical esophagogastrostomy may become difficult. Estimation of an individual probability could help to establish preventive and diagnostic measures. The predictive impact of epidemiological, surgery-related data and laboratory parameters on the development of anastomotic dehiscence was investigated in the immediate perioperative period. METHODS: Retrospective study in 412 patients with cervical esophagogastrostomy following esophagectomy. Epidemiological data, risk factors, underlying disease, pre-treatment- and surgery-related data, C-reactive protein and albumin levels pre-and post-operatively were evaluated. We applied univariable and multivariable logistic regression analysis and developed a nomogram for individual risk assessment. RESULTS: There were 345 male, 67 female patients, mean aged 61.5 years; 284 had orthotopic, 128 retrosternal gastric pull-up; 331 patients had carcinoma, 81 non-malignant disease. Mean duration of operation was 184 min; 235 patients had manual, 113 mechanical and 64 semi-mechanical suturing; 76 patients (18.5%) developed anastomotic dehiscence clinically evident at mean 11.4 days after surgery. In univariable testing young age, retrosternal conduit transposition, manual suturing, high body mass index, high ASA and high postoperative levels of C-reactive protein were predictors for anastomotic leakage. These six parameters which had yielded a p < 0.1 in the univariable analysis, were entered into a multivariable analysis and a nomogram allowing the determination of the patient's individual risk was created. CONCLUSION: By using the nomogram as a supportive measure in the perioperative management, the patient's individual probability of developing an anastomotic leak could be quantified which may help to take preventive measures improving the outcome.
Assuntos
Fístula Anastomótica , Neoplasias Esofágicas , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nomogramas , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: The knowledge of both patterns and risk of relapse following resection for esophageal cancer is crucial for establishing appropriate surveillance schedules. The aim of this study was to evaluate the pattern of hazards for tumor recurrence and tumor-related death in the postoperative long-term follow-up after esophagectomy. METHODS: Retrospective single-center analysis of 362 patients, with resected esophageal cancer. Multivariate Cox proportional hazard model was used. RESULTS: A total of 192 (53%) had postoperative tumor recurrence. The relapse patterns of adenocarcinoma and squamous-cell carcinoma showed that each had a single peak, 12 months after surgery. After induction there was one peak at 5 months, the non-induced patients peaked 11 months, postoperatively. At 18 months, the recurrence hazard declined sharply in all cases. The hazard curves for tumor-related death were bimodal for adenocarcinoma, with two peaks at 6 and 22 months and one single peak for squamous-cell carcinoma at 18 months after surgery, showing pronounced decline later on. CONCLUSION: In curatively resected esophageal cancer, both tumor recurrence hazard and hazard for tumor-related death showed distinct, partly bimodal patterns. It could be justified to intensify the surveillance during the first two postoperative years by initiating a close-meshed follow-up to detect and treat tumor recurrence, as early as possible.
RESUMO
INTRODUCTION: Better treatment options entail the risk of multiple tumors in a patient's lifetime. We studied the incidence, risk factors, and prognostic impact of second primaries and other malignancies in patients with operated non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: We retrospectively analyzed 342 consecutive patients with curatively resected NSCLC between 2003 and 2007. RESULTS: Among the 342 patients analyzed, 172 (50.3%) developed locoregional and/or distant recurrence; 25 (7.3%) had a second primary lung cancer, 97 (28.3%) had 1 or more malignancies other than NSCLC either in their history (n = 61; 17.8%) or following resection (n = 64; 18.7%). One hundred fifteen patients (33.6%) had a malignancy other than primary NSCLC. Eight patients developed both a second primary lung cancer and another malignancy. Older age and lower N-stage were significantly correlated with the occurrence of an additional tumor, as shown by a logistic regression nomogram. Whereas the risk of recurrence decreases over time, the risk of developing a second tumor, particularly a second primary lung cancer, remains high during up to 10 years of follow-up. One hundred seventy patients (49.7%) died of the primary (n = 158; 46.2%) or second primary (n = 12; 3.5%) NSCLC, 23 (6.7%) died of another malignancy, and 66 (19.3%) died due to unrelated causes (overall 10-year survival, 33.3%). CONCLUSIONS: Second primary lung cancer or other malignancy occurs in 33% of patients with NSCLC; 26% of patients are affected within 10 years after resection of lung cancer. With curative treatment of secondary tumors, there is no negative influence on long-term prognosis of NSCLC; therefore, follow-up beyond 5 years is strongly advisable.
Assuntos
Adenocarcinoma de Pulmão/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Pneumonectomia/efeitos adversos , Adenocarcinoma de Pulmão/patologia , Idoso , Áustria/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Incidência , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/patologia , Segunda Neoplasia Primária/etiologia , Segunda Neoplasia Primária/patologia , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Cells in the central nervous system rely almost exclusively on aerobic metabolism. Oxygen deprivation, such as injury-associated ischemia, results in detrimental apoptotic and necrotic cell loss. There is evidence that repetitive hyperbaric oxygen therapy (HBOT) improves outcomes in traumatic brain-injured patients. However, there are no experimental studies investigating the mechanism of repetitive long-term HBOT treatment-associated protective effects. We have therefore analysed the effect of long-term repetitive HBOT treatment on brain trauma-associated cerebral modulations using the lateral fluid percussion model for rats. Trauma-associated neurological impairment regressed significantly in the group of HBO-treated animals within three weeks post trauma. Evaluation of somatosensory-evoked potentials indicated a possible remyelination of neurons in the injured hemisphere following HBOT. This presumption was confirmed by a pronounced increase in myelin basic protein isoforms, PLP expression as well as an increase in myelin following three weeks of repetitive HBO treatment. Our results indicate that protective long-term HBOT effects following brain injury is mediated by a pronounced remyelination in the ipsilateral injured cortex as substantiated by the associated recovery of sensorimotor function.
Assuntos
Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/terapia , Oxigenoterapia Hiperbárica , Bainha de Mielina/fisiologia , Desempenho Psicomotor , Recuperação de Função Fisiológica , Animais , Encéfalo/patologia , Encéfalo/fisiopatologia , Lesões Encefálicas/patologia , Potenciais Evocados , Masculino , Ratos , Ratos Sprague-Dawley , Fatores de TempoRESUMO
INTRODUCTION: Many transplant studies in elderly patients focus on survival and mortality rates. It was the aim of this review to evaluate publications dealing with individual patient performance and independence. METHODS: The literature search included all articles retrievable for the hit "transplantation in elderly recipients" between 1960 and 2010. For quality search the inclusion criteria were as follows: older than 60 years and transplanted kidney, liver, heart, lung or pancreas from a deceased or living donor. We focussed on parameters concerning quality of life, frailty, nutritional status/weight loss, drugs/interactions/polypharmacy, gait/osteoporosis/fracture, delirium/dementia and geriatric assessment to address physical and psychosocial functionality of elderly recipients. RESULTS: The initial hit list contained 1427 citations from electronic databases. 249 abstracts thereof were selected for full review. A total of 60 articles met final inclusion criteria. Finally, only five studies met the qualitative inclusion criteria as listed above. CONCLUSION: The number of elderly patients placed on waiting lists has increased dramatically and will further grow. Interdisciplinary collaboration and distinct patient selection is recommended in most of the studies. However, data concerning quality of life and related parameters in elderly transplant recipients are rare.
Assuntos
Idoso Fragilizado , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/tendências , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Idoso Fragilizado/psicologia , Humanos , Transplante de Órgãos/psicologia , Seleção de Pacientes/ética , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/psicologia , Qualidade de Vida/psicologiaRESUMO
OBJECTIVES: the objective of the present investigation was to measure the extracellular concentrations of cefpirome in unaffected and infected lung tissue of septic patients. METHODS: a single intravenous dose of 30 mg/kg total body weight of cefpirome was administered to eight patients every 12 h prior to insertion of microdialysis probes into lung tissue. RESULTS: the median (minimum, maximum) peak concentration (C(max)), time to C(max) (T(max)), area under the concentration-time curve from 0 to 4 h (AUC(0-4)) and AUC(0-∞) of unbound cefpirome for unaffected lung were 48 (32, 107) mg/L, 0.83 (0.17, 3.17) h, 117 (60, 177) mgâ·âh/L and 182 (80, 382) mgâ·âh/L, respectively. The corresponding values for infected lung tissue were 45 (6, 122) mg/L, 1.17 (0.83, 2.83) h, 92 (17, 253) mgâ·âh/L and 206 (49, 379) mgâ·âh/L, respectively. The median apparent terminal elimination half-lives (t(½z)) of cefpirome were 2.61, 3.05 and 3.39 h for plasma, unaffected lung and infected lung, respectively. The median ratios of the AUC(0)(-∞) for lung to the AUC(0)(-∞) for plasma were 0.63 (0.19, 1.55) and 0.46 (0.32, 0.98) for unaffected and infected lung, respectively. CONCLUSIONS: we provide strong evidence that cefpirome penetrates effectively into the extracellular space fluid of lung tissue. Under steady-state conditions, the median concentrations of cefpirome in plasma, unaffected lung and infected lung exceeded the MICs of the majority of relevant bacteria over the entire dosing interval of up to 12 h after intravenous administration of a dose of 30 mg/kg total body weight.
Assuntos
Antibacterianos/farmacocinética , Cefalosporinas/farmacocinética , Pulmão/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Cefalosporinas/administração & dosagem , Feminino , Humanos , Injeções Intravenosas , Pulmão/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , CefpiromaRESUMO
If undiagnosed, traumatic pericardial rupture with herniation of the heart may have fatal consequences. We report two cases of multiple trauma with pericardial rupture, which was missed in the preoperative diagnoses of both patients, in spite of suggestive signs on computed tomographic scans. One patient had unexplained, persistent hemodynamic instability; the second patient had cardiac arrest during laparotomy for minor hepatic laceration. In both, the left-sided rupture of the pericardium with cardiac herniation into the pleural space was found and corrected in an emergency intervention. Both patients recovered completely.
Assuntos
Cardiopatias/etiologia , Hérnia/etiologia , Pericárdio/lesões , Cardiopatias/diagnóstico por imagem , Hérnia/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio/diagnóstico por imagem , Radiografia , Ruptura/complicações , Ruptura/diagnóstico por imagemRESUMO
OBJECTIVES: The present investigation explored the ability of fosfomycin to penetrate lung tissue of septic patients by utilizing the microdialysis technique. METHODS: After microdialysis probe insertion into healthy and infected lung tissue, a single intravenous dose of 4 g of fosfomycin was administered. RESULTS: The mean C(max), T(max), AUC(0-4) and AUC(0-infinity) for healthy lung were 131.6 +/- 110.6 mg/L, 1.1 +/- 0.4 h, 242.4 +/- 101.6 mgxh/L and 367.6 +/- 111.9 mgxh/L, respectively. The corresponding values for infected lung were 107.5 +/- 60.2 mg/L, 1.4 +/- 0.5 h, 203.5 +/- 118.4 mgxh/L and 315.1 +/- 151.2 mgxh/L. The half-life of fosfomycin ranged from 2.2 to 2.7 h between compartments. The magnitude of lung tissue penetration, as determined by the ratios of the AUC(0-infinity) for lung to the AUC(0-infinity) for plasma, was 0.63 +/- 0.31 and 0.53 +/- 0.31 for healthy and infected lung, respectively. CONCLUSIONS: We conclude that fosfomycin achieves antimicrobially effective concentrations in infected lung tissue.
Assuntos
Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Fosfomicina/farmacocinética , Fosfomicina/uso terapêutico , Pulmão/química , Sepse/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Feminino , Fosfomicina/administração & dosagem , Meia-Vida , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-IdadeRESUMO
From January 2003 to June 2006, 6 patients with leakage of the cervical esophagogastrostomy after esophagectomy and gastric pull-up underwent endoscopic stenting using the self-expandable covered tracheal type device. Anastomotic healing was satisfactory. Stent extraction was performed after an average interval of 91 days. Initial stent migration occurred in 2 patients and post-extraction stenosis developed in 3 patients. Insertion of a self-expandable covered metal tracheal stent represents a safe approach resulting in immediate closure and subsequent healing of cervical anastomotic leakage.
Assuntos
Anastomose Cirúrgica/efeitos adversos , Oclusão com Balão/instrumentação , Fístula Esofágica/terapia , Esofagoscopia/métodos , Gastrostomia/efeitos adversos , Stents , Anastomose Cirúrgica/métodos , Materiais Revestidos Biocompatíveis , Fístula Esofágica/etiologia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Esofagectomia/métodos , Feminino , Seguimentos , Humanos , Masculino , Metais , Complicações Pós-Operatórias , Estudos Retrospectivos , Medição de Risco , Resultado do TratamentoRESUMO
We report a 72-year-old man suffering from pleural empyema after pneumonectomy due to nonsmall cell lung cancer 20 years previously. Insufficiency of the bronchial stump was ruled out by bronchoscopy and bronchography. Thoracic computed tomographic scan of the thorax detected an abscess located in the subcutaneous tissue of the right ventrolateral chest wall originating from severe pyogenic osteomyelitis of the fifth and sixth ribs. Our surgical management included partial resection of the chest wall followed by insertion of the vacuum-assisted closure system into the thoracic cavity. The patient fully recovered and was discharged on postoperative day 32.
Assuntos
Empiema Pleural/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Sucção/instrumentação , Técnicas de Sutura/instrumentação , Idoso , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , VácuoRESUMO
INTRODUCTION: In esophageal cancer, the liver, lung, and bones are the most common sites of visceral metastases. Isolated chest wall metastases are quite extraordinary and occur very rarely. METHODS: In February 2004, a 59-year-old male patient was admitted with esophageal adenocarcinoma. Preoperative routine staging failed to detect any metastases. A transhiatal esophagectomy and retrosternal gastric pull-up with cervical esophago-gastrostomy were performed. The definitive histopathological staging showed an adenocarcinoma, Union Internationale Contre le Cancer stage I. The first check-up 6 months later consisted of a computed tomographic scan of the neck, thorax, and abdomen as well as endoscopy, and raised no suspicion of distant metastases and/or local recurrence. We detected an isolated subcutaneous tumor at the area of the right ventrolateral chest wall 18 months after surgery. The magnetic resonance tomography scan of the thorax showed a solid subcutaneous expansion. The surgical biopsy of this lesion confirmed the suspicion of an isolated chest wall metastasis of the resected esophageal adenocarcinoma. RESULTS: A complete resection of the metastasis was performed without any complications, and the chest wall deficiency became stabilized using a Prolene-Mesh and could be closed directly by skin and subcutaneous tissue. CONCLUSIONS: In case of transhiatal esophageal resection without operative participation of the chest wall, an isolated thoracic wall metastasis can be explained by an occult widespread dissemination of the tumor cells along the extensive esophageal lymphatic and hematogenous system. The final decision of surgical resection of this chest wall metastasis should always be made by an interdisciplinary tumor board.
Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia , Neoplasias Torácicas/secundário , Neoplasias Torácicas/cirurgia , Parede Torácica , Neoplasias Esofágicas/diagnóstico , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In cases of permanent tracheostomy after laryngectomy, tracheo-bronchial stenting may cause serious respiratory problems due to the absence of airway humidification and the inability to cough forcefully. We report 2 patients with permanent tracheostomy who underwent stenting and developed recurrent episodes of asphyxia due to stent obstruction by dried mucus. The indication for stenting of the airways must be established with great care in patients with permanent tracheostomy.
Assuntos
Obstrução das Vias Respiratórias/terapia , Laringectomia/efeitos adversos , Stents/efeitos adversos , Traqueia/cirurgia , Traqueostomia/efeitos adversos , Obstrução das Vias Respiratórias/etiologia , Brônquios/cirurgia , Humanos , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
Extraskeletal osteomas have not been described in the lung. Tumors with osseous elements can be found, such as hamartoma and amyloid tumor, and reactive lesions such as osseous metaplasia. A 39-year-old male patient was treated for multiple myeloma and got a bone marrow transplantation 2 years and a few months before he presented with a solitary well-circumscribed tumor in the right middle lobe. The patient underwent surgical resection. The tumor presented with a fibrous capsule and consisted of mature bone trabecules. Within the tumor, fatty tissue was seen. There were small bone spicules interpreted as areas of new bone formation and appositional growth. No amyloid deposition, no immature epithelial tubules as in hamartomas, and no normal lung structure as in osseous metaplasia were seen. Within the osseous elements, a positive reaction was seen with antibodies for osteonectin, whereas the reaction for calcitonin was negative. To the best of our knowledge, this is the first case of an osteoma being reported in the lung looking like any other extraskeletal osteoma. This tumor might have been induced by circulating stem cells; however, due to autologous bona marrow transplantation, this cannot be proven.
Assuntos
Neoplasias Ósseas/patologia , Neoplasias Pulmonares/patologia , Segunda Neoplasia Primária/patologia , Ossificação Heterotópica/patologia , Osteoma/patologia , Adulto , Biomarcadores Tumorais/análise , Transplante de Medula Óssea , Neoplasias Ósseas/química , Neoplasias Ósseas/cirurgia , Diagnóstico Diferencial , Hamartoma/diagnóstico , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/química , Neoplasias Pulmonares/cirurgia , Masculino , Mieloma Múltiplo/patologia , Mieloma Múltiplo/terapia , Segunda Neoplasia Primária/química , Segunda Neoplasia Primária/cirurgia , Osteoma/química , Osteoma/cirurgia , Osteonectina/análiseRESUMO
BACKGROUND: Metastatic tumors of the intestinal tract from extra-abdominal sites are rare. In esophageal cancer, the liver, lung and the bones are the most common sites of metastases. Metastasis to intestines are very rare. CASE PRESENTATION: A 54-year old male was admitted with esophageal squamous cell carcinoma (SCC) associated with dysphagia II-III and weight loss of 20 kg. Preoperative routine staging failed to detect any metastases. A transthoracic esophagectomy and orthotopic gastric pull-up with collar esophago-gastrostomy, associated with 2-field lymphadenectomy was performed. During the digital placement of the naso-jejunal feeding catheter a submucosal jejunal nodule with a diameter of 1 cm, about 40 cm distal to the duodeno-jejunal fold was detected which was completely resected by jejunotomy. Histopathology of jejunal nodule showed metastasis from esophageal squamous cell carcinoma. CONCLUSION: Because of the extensive esophageal lymphatic system, an occult widespread dissemination of the tumor cells into the abdominal cavity is possible. Additional intraoperative evaluation of the small intestine and the complete abdominal cavity should be performed in every operation of esophageal carcinoma to detect possible occult intraabdominal metastases.