RESUMO
The diagnosis of thoracic endometriosis (TE) is challenging, hence resulting in under-diagnosis as well as long delays before arriving at a correct definitive diagnosis. Our aim is to review the histopathological findings in TE, summarise the diagnostic features, identify any major histo-morphological indicator(s) hitherto unrecognised as such, suggest diagnostic criteria; all with the aim of improving the diagnostic capacity and reducing observer error even where the clinical suspicion is low. A case-control study in which a search in the pathology archives of a referral hospital over a 10-year period was conducted. Twenty-six cases of TE were identified, reviewed, and compared with a control population of 48 cases taken from common benign thoracic diseases. Nine notable histological features were identified in varying permutations in the test group, namely: endometrioid glands, lymphoid clusters, ceroid macrophages, siderophages, cholesterol crystals, capillary congestion, multinucleated giant cells, smooth muscle bundles and fibrosis. The first 6 features were frequent; each being present in over 13 (13/26; 50%) test cases. The first 8 features showed significant association with TE by the Chi-squared test (P<0.05). In this group, the strength of association is high for the first 4 features (Cramér's V≥0.5). The presence of ceroid macrophages is shown to be a novel key feature, previously unrecognised as such, for the identification of TE. The presence of any three of four features including endometrioid glands, lymphoid clusters, ceroid macrophages and siderophages is a suggested criterion for the definitive diagnosis of TE.
Assuntos
Endometriose/diagnóstico , Coloração e Rotulagem/métodos , Doenças Torácicas/diagnóstico , Adulto , Estudos de Casos e Controles , Endometriose/fisiopatologia , Endométrio/patologia , Feminino , Humanos , Linfócitos/patologia , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Retrospectivos , Doenças Torácicas/fisiopatologia , Tórax/anatomia & histologia , Tórax/patologia , Útero/anatomia & histologia , Útero/patologiaRESUMO
BACKGROUND: Over the past 100 years, many procedures have been developed for correcting restrictive thoracic deformities which cause thoracic insufficiency syndrome. However, none of them have been assessed by a robust metric incorporating thoracic dynamics. In this paper, we investigate the relationship between radiographic spinal curve and lung volumes derived from thoracic dynamic magnetic resonance imaging (dMRI). Our central hypothesis is that different anteroposterior major spinal curve types induce different restrictions on the left and right lungs and their dynamics. METHODS: Retrospectively, we included 25 consecutive patients with thoracic insufficiency syndrome (14 neuromuscular, 7 congenital, 4 other) who underwent vertical expandable prosthetic titanium rib surgery and received preimplantation and postimplantation thoracic dMRI for clinical care. We measured thoracic and lumbar major curves by the Cobb measurement method from anteroposterior radiographs and classified the curves as per Scoliosis Research Society (SRS)-defined curve types. From 4D dMRI images, we derived static volumes and tidal volumes of left and right lung, along with left and right chest wall and left and right diaphragm tidal volumes (excursions), and analyzed their association with curve type and major curve angles. RESULTS: Thoracic and lumbar major curve angles ranged from 0 to 136 and 0 to 116 degrees, respectively. A dramatic postoperative increase in chest wall and diaphragmatic excursion was seen qualitatively. All components of volume increased postoperatively by up to 533%, with a mean of 70%. As the major curve, main thoracic curve (MTC) was associated with higher tidal volumes (effect size range: 0.7 to 1.0) than thoracolumbar curve (TLC) in preoperative and postoperative situation. Neither MTC nor TLC showed any meaningful correlation between volumes and major curve angles preoperatively or postoperatively. Moderate correlations (0.65) were observed for specific conditions like volumes at end-inspiration or end-expiration. CONCLUSIONS: The relationships between component tidal volumes and the spinal curve type are complex and are beyond intuitive reasoning and guessing. TLC has a much greater influence on restricting chest wall and diaphragm tidal volumes than MTC. Major curve angles are not indicative of passive resting volumes or tidal volumes. LEVEL OF EVIDENCE: Level II-diagnostic.
Assuntos
Imageamento por Ressonância Magnética/métodos , Implantação de Prótese , Insuficiência Respiratória , Costelas/cirurgia , Escoliose , Doenças Torácicas , Adolescente , Criança , Feminino , Humanos , Masculino , Equipamentos Ortopédicos , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/prevenção & controle , Estudos Retrospectivos , Escoliose/complicações , Escoliose/diagnóstico , Escoliose/fisiopatologia , Escoliose/cirurgia , Doenças Torácicas/diagnóstico , Doenças Torácicas/etiologia , Doenças Torácicas/fisiopatologia , Doenças Torácicas/cirurgia , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Resultado do TratamentoRESUMO
BACKGROUND: Thoracic endometriosis syndrome (TES) is a rare condition that occurs in women when endometriosis implants into the thoracic cavity. Catamenial hemoptysis, the occurrence of hemoptysis with menstruation, is a recognized clinical manifestation of TES commonly treated with hormonal therapy. CASE SUMMARY: We present the first documented case describing the recrudescence of catamenial hemoptysis in the setting of Lumacaftor/Ivacaftor administration in a 25-year-old woman with cystic fibrosis (CF). DISCUSSION: We review the literature on TES, pharmacologic management, and reported cystic fibrosis transmembrane conductance regulator (CFTR) modulator drug interactions. We propose that our patient's recrudescence of catamenial hemoptysis was secondary to a drug-drug interaction between Lumacaftor/Ivacaftor and oral contraceptive therapy. CONCLUSION: Our case suggests that women with CF who have catamenial hemoptysis and a genetic mutation approved for Tezacaftor/Ivacaftor or Elexacaftor/Tezacaftor/Ivacaftor can be managed effectively with either CFTR modulator and hormonal contraceptive therapy.
Assuntos
Aminofenóis/uso terapêutico , Aminopiridinas/uso terapêutico , Benzodioxóis/uso terapêutico , Fibrose Cística , Endometriose , Hemoptise , Indóis/uso terapêutico , Leuprolida/administração & dosagem , Pirazóis/uso terapêutico , Piridinas/uso terapêutico , Quinolinas/uso terapêutico , Quinolonas/uso terapêutico , Adulto , Broncoscopia/métodos , Agonistas dos Canais de Cloreto/uso terapêutico , Fibrose Cística/complicações , Fibrose Cística/diagnóstico , Fibrose Cística/tratamento farmacológico , Fibrose Cística/fisiopatologia , Combinação de Medicamentos , Quimioterapia Combinada/métodos , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/tratamento farmacológico , Endometriose/fisiopatologia , Feminino , Fármacos para a Fertilidade Feminina/administração & dosagem , Hemoptise/diagnóstico , Hemoptise/etiologia , Hemoptise/prevenção & controle , Humanos , Radiografia Torácica/métodos , Doenças Torácicas/complicações , Doenças Torácicas/diagnóstico , Doenças Torácicas/tratamento farmacológico , Doenças Torácicas/fisiopatologia , Tomografia Computadorizada por Raios X/métodosRESUMO
Unlike general anaesthesia, neuraxial anaesthesia (NA) reduces the burden and risk of respiratory adverse events in the post-operative period. However, both patients affected by chronic obstructive pulmonary disease (COPD) and chest wall disorders and/or neuromuscular diseases may experience the development or the worsening of respiratory failure, even during surgery performed under NA; this latter negatively affects the function of accessory respiratory muscles, resulting in a blunted central response to hypercapnia and possibly in an exacerbation of cardiac dysfunction (NA-induced relative hypovolemia). According to European Respiratory Society (ERS) and American Thoracic Society (ATS) guidelines, non-invasive ventilation (NIV) is effective in the post-operative period for the treatment of both impaired pulmonary gas exchange and ventilation, while the intra-operative use of NIV in association with NA is just anecdotally reported in the literature. Whilst NIV does not assure a protected patent airway and requires the patient's cooperation, it is a handy tool during surgery under NA: NIV is reported to be successful for treatment of acute respiratory failure; it may be delivered through the patient's home ventilator, may reverse hypoventilation induced by sedatives or inadvertent spread of anaesthetic up to cervical dermatomes, and allow the avoidance of intubation in patients affected by chronic respiratory failure, prolonging the time of non-invasiveness of respiratory support (i.e., neuromuscular patients needing surgery). All these advantages could make NIV preferable to oxygen in carefully selected patients.
Assuntos
Anestesia Epidural/métodos , Raquianestesia/métodos , Ventilação não Invasiva/métodos , Humanos , Doenças Neuromusculares/complicações , Doenças Neuromusculares/fisiopatologia , Seleção de Pacientes , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/prevenção & controle , Doenças Torácicas/complicações , Doenças Torácicas/fisiopatologiaRESUMO
BACKGROUND AND OBJECTIVE: The mechanism of dyspnoea associated with pleural effusion is uncertain. A cohort of patients requiring thoracoscopy for unilateral exudative effusion were investigated for associations between dyspnoea and suggested predictors: impaired ipsilateral diaphragm movement, effusion volume and restricted lung inflation. METHODS: Baseline Dyspnoea Index, respiratory function, and ultrasound assessment of ipsilateral diaphragm movement were assessed prior to thoracoscopy, when effusion volume was measured. Transitional Dyspnoea Index (change from baseline) was assessed 4 and 8 weeks after thoracoscopy. Pearson product moment assessed bivariate correlations and a general linear model examined how well total lung capacity (measuring restricted lung inflation), effusion volume and impaired diaphragm movement predicted Baseline Dyspnoea Index. Un-paired t tests compared the groups with normal and impaired diaphragm movement. RESULTS: 19 patients were studied (14 malignant etiology). Total lung capacity was associated with Baseline Dyspnoea Index (r = 0.68, P = 0.003). Effusion volume (r = -0.138, P = 0.60) and diaphragm movement (P = 0.09) were not associated with Baseline Dyspnoea Index. Effusion volume was larger with impaired diaphragm movement compared to normal diaphragm movement (2.16 ±SD 0.95 vs.1.16 ±0.92 L, P = 0.009). Total lung capacity was lower with impaired diaphragm movement compared to normal diaphragm movement (65.4 ±10.3 vs 78.2 ±8.6% predicted, P = 0.011). The optimal general linear model to predict Baseline Dyspnoea Index used total lung capacity alone (adjusted R2 = 0.42, P = 0.003). In nine participants with controlled effusion, baseline effusion volume (r = 0.775, P = 0.014) and total lung capacity (r = -0.690, P = 0.040) were associated with Transitional Dyspnoea Index. CONCLUSIONS: Restricted lung inflation was the principal predictor of increased dyspnoea prior to thoracoscopic drainage of effusion, with no independent additional association with either effusion volume or impaired ipsilateral diaphragm movement. Restricted lung inflation may be an important determinant of the dyspnoea associated with pleural effusion.
Assuntos
Dispneia/fisiopatologia , Pulmão/fisiopatologia , Derrame Pleural/fisiopatologia , Respiração , Monóxido de Carbono/metabolismo , Cromatografia em Camada Fina , Diafragma/fisiopatologia , Feminino , Humanos , Masculino , Pleura/fisiopatologia , Doenças Torácicas/fisiopatologiaAssuntos
Nódulos Pulmonares Múltiplos/etiologia , Nódulos Pulmonares Múltiplos/cirurgia , Doenças Torácicas/complicações , Doenças Torácicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/fisiopatologia , Doenças Raras/complicações , Doenças Raras/fisiopatologia , Doenças Raras/cirurgia , Doenças Torácicas/fisiopatologia , Resultado do TratamentoRESUMO
AIM: To assess the prevalence and prognostic significance of additional intrathoracic findings (AIFs) in patients with cancer and pulmonary embolism (PE). AIFs were considered alterations other than the characteristic ones intrinsic to PE or changes in cardiovascular morphology. METHODS: Subjects have been taken from a Spanish national multidisciplinary and multicenter study of PE and cancer who were treated between 2004 and 2015. The endpoint was the appearance of serious complications or death within 15 days. RESULTS: The registry contains 1024 eligible patients; 41% diagnosed by computed tomography pulmonary angiography versus 59% by non-angiographic CT. Serious complications occurred within 15 days in 18.9%, [95% confidence interval (CI), 16.6-21.4%] and 9.5% (95% CI 7.9-11.5%) died. At least one AIF was seen in 72.6%. The most common AIFs were as follows: pulmonary nodules (30.9%), pleural effusion (30.2%), tumor progression (28.3%), atelectasis (19.0%), pulmonary infarct (15.2%), emphysema (13.4%), pulmonary lymphangitic carcinomatosis (4.5%), and pneumonia (6.1%). Patients with AIF exhibited a higher complication rate at 15 days: 21.9% versus 13.0%, odds ratio (OR) 1.8 (95% CI 1.2-2.8), P = 0.03, and 15-day mortality: 15.0% versus 7.3%, OR 1.9 (95% CI 1.1-3.2), P = 0.020. Patients with pneumonia, pneumothorax, pulmonary edema, pulmonary nodules, tumor progression, pulmonary fibrosis, and pleural effusion showed an excess of adverse events. CONCLUSIONS: Additional intrathoracic findings are highly prevalent and significantly impact prognosis in patients with PE and cancer, making them germane to the classification of this population.
Assuntos
Neoplasias/complicações , Embolia Pulmonar/mortalidade , Embolia Pulmonar/patologia , Doenças Torácicas/fisiopatologia , Tórax/patologia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Embolia Pulmonar/etiologia , Medição de Risco , Taxa de SobrevidaRESUMO
PURPOSE: An increasing number of thoracic decortications have been performed in Manitoba, from five in 2007 to 45 in 2014. The primary objective of this study was to define the epidemiology of decortications in Manitoba. The secondary objective was to compare patients who underwent decortication due to primary infectious vs non-infectious etiology with respect to their perioperative outcomes. METHODS: Data for this cohort study were extracted from consecutive charts of all adult patients who underwent a decortication in Manitoba from 2007-2014 inclusive. RESULTS: One hundred ninety-two patients underwent a decortication. The most frequent disease processes resulting in a decortication were pneumonia (60%), trauma (13%), malignancy (8%), and procedural complications (5%). The number of decortications due to complications of pneumonia rose at the greatest rate, from three cases in 2007 to 29 cases in 2014. Performing a decortication for an infectious vs a non-infectious etiology was associated with a higher rate of the composite postoperative outcome of myocardial infarction, acute kidney injury, need of vasopressors for > 12 hr, and mechanical ventilation for > 48 hr (44.4% vs 24.2%, respectively; relative risk, 1.83; 95% confidence interval, 1.1 to 2.9; P = 0.01). CONCLUSION: There has been a ninefold increase in decortications over an eight-year period. Potential causes include an increase in the incidence of pneumonia, increased organism virulence, host changes, and changes in practice patterns. Patients undergoing decortication for infectious causes had an increased risk for adverse perioperative outcomes. Anesthesiologists need to be aware of the high perioperative morbidity of these patients and the potential need for postoperative admission to an intensive care unit.
Assuntos
Assistência Perioperatória/métodos , Complicações Pós-Operatórias/epidemiologia , Doenças Torácicas/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Adulto , Idoso , Anestesiologia/métodos , Estudos de Coortes , Feminino , Humanos , Masculino , Manitoba , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças Torácicas/epidemiologia , Doenças Torácicas/fisiopatologia , Resultado do TratamentoRESUMO
Thoracic insufficiency syndrome (TIS) is a broad grouping of disorders that have a substantial impact on the chest wall, spine, and in many situations, both. While the conditions are varied, they share a potentially substantial impact on respiratory capacity and development over time and a presentation and need for intervention that is often in early childhood. Addressing these conditions has required a new paradigm that involves both deformity correction and a preservation of growth capacity. While there are now a number of options to treat severe spinal deformity early in life, when the deformity causes or is caused by a chest wall deformity, the Vertical Expandable Prosthetic Titanium Rib(VEPTR) is able to support surgical correction of both. The skeletal correction is often quite dramatic, but the functional measurements of quality of life and pulmonary function often do not show as dramatic and improvement, but consistently show a stabilization indicating control of the progressive thoracospinal disorder that produced TIS.
Assuntos
Doenças da Coluna Vertebral , Doenças Torácicas , Criança , Pré-Escolar , Comorbidade , Síndrome de Ellis-Van Creveld/diagnóstico , Síndrome de Ellis-Van Creveld/terapia , Humanos , Qualidade de Vida , Doenças Respiratórias/fisiopatologia , Doenças Respiratórias/terapia , Doenças da Coluna Vertebral/congênito , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/fisiopatologia , Doenças da Coluna Vertebral/terapia , Doenças Torácicas/congênito , Doenças Torácicas/diagnóstico , Doenças Torácicas/fisiopatologia , Doenças Torácicas/terapiaRESUMO
It was analyzed own experience of diagnosis and treatment of catamenial (menstrual) pneumothorax and thoracic endometriosis and literature review. It is shown that catamenial pneumothorax has specific clinical and instrumental signs allowing to establish the diagnosis before surgery. It was proposed surgical treatment including the removal of trans diaphragmatic way of pneumothorax development, removal of thoracic endometriosis and the establishment of reliable pleurodesis. It was demonstrated that this volume of surgery can be successfully implemented by using of thoracoscopic access. Relapse prevention includes hormonal therapy for the 6 months after surgery under the supervision of an obstetrician-gynecologist.
Assuntos
Diafragma , Endometriose , Hormônio Liberador de Gonadotropina/análogos & derivados , Pleurodese/métodos , Pneumotórax , Adulto , Diafragma/patologia , Diafragma/cirurgia , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/fisiopatologia , Endometriose/cirurgia , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Pneumotórax/fisiopatologia , Pneumotórax/cirurgia , Período Pós-Operatório , Prevenção Secundária/métodos , Cavidade Torácica/patologia , Cavidade Torácica/cirurgia , Doenças Torácicas/complicações , Doenças Torácicas/diagnóstico , Doenças Torácicas/fisiopatologia , Doenças Torácicas/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Resultado do TratamentoRESUMO
Thoracic hematogenic endometriosis is a rare pathology. A clinical course hasn't pathognomic symptoms, because of it, the diagnosis is established due to histological study. The article presented two cases of female patients, who were suffering from thoracic endometriosis. They were hospitalized to the department of thoracic surgery of Municipal multifield hospital No 2 in Saint-Petersburg. The first patient had a posterior mediastinum tumor with asymptomatic disease course. The second patient was with recurrent catamenial pneumothorax.
Assuntos
Endometriose , Pneumotórax , Doenças Torácicas , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/fisiopatologia , Endometriose/cirurgia , Feminino , Humanos , Mediastino/patologia , Pessoa de Meia-Idade , Pneumotórax/etiologia , Pneumotórax/cirurgia , Doenças Torácicas/complicações , Doenças Torácicas/diagnóstico , Doenças Torácicas/fisiopatologia , Doenças Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Positron emission tomography computed tomography(PET-CT) imaging has emerged as an essential clinical diagnostic tool in the evaluation of thoracic abnormalities. Currently, its primary role is for tumor imaging; it helps to differentiate benign from malignant nodules, stage tumors, determine response, and follow patients after therapy is complete. It has also been used for nononcologic diseases, but the indications are less well defined. PET is a fundamental component of the molecular imaging initiative, and as new more specific imaging probes and better instrumentation are developed, PET-CT is certain to improve diagnostic accuracy and become even more integrated into the imaging armamentarium.
Assuntos
Tomografia por Emissão de Pósitrons/métodos , Doenças Torácicas/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Animais , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Nódulo Pulmonar Solitário/diagnóstico , Nódulo Pulmonar Solitário/patologia , Doenças Torácicas/fisiopatologiaAssuntos
Hérnia/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Doenças Torácicas/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Feminino , Hemangioma/cirurgia , Hérnia/etiologia , Hérnia/fisiopatologia , Herniorrafia , Humanos , Músculos Intercostais/fisiopatologia , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Costelas/cirurgia , Doenças Torácicas/etiologia , Doenças Torácicas/fisiopatologia , Neoplasias Torácicas/cirurgiaRESUMO
STUDY DESIGN: Retrospective analysis of 1328 spinal radiographs of 57 patients after vertical expandable prosthetic titanium rib (VEPTR) implantation with an average follow-up of 30 months. OBJECTIVE: To evaluate the incidence, time of onset, as well as the underlying factors influencing the occurrence of ossifications in children treated with VEPTR. SUMMARY OF BACKGROUND DATA: Spontaneous spinal fusions and ossifications are well known in children treated with spinal implants. In theory, children with spinal deformity and VEPTR implantation are less likely to develop these complications because of either little or no implant contact to the spine. METHODS: Fifty-seven patients had a primary VEPTR implantation due to spinal deformity and thoracic insufficiency syndrome and repeated lengthening procedures. The mean age at the time of primary surgery was 7.7 years, the mean duration of follow-up was 29.8 months, and the mean number of operations was 5.9. A total of 1328 spinal radiographs were analyzed with respect to the occurrence and growth of ossifications, implant migration, and other complications. RESULTS: Overall, 24% of the patients (n = 13) had ossifications, which affected in 92% the main load sharing VEPTR implant. The fusions involved in 54% of cases the lumbar spine and in each 23% the ribs and the iliac crest. Ossifications developed in 11% of children within the first year of treatment and increased by about the same rate per annum. After 53 months, 48% of the radiographs showed some ossifications. There was a significant correlation to the stiffness of the deformity and the number of surgical procedures. CONCLUSION: Contrary to previous assumptions, it was shown that in children treated with the VEPTR system, 48% of children showed ossifications after 53 months. Ossifications were observed significantly more often in children with stiff deformities and after multiple surgical procedures. It is a much more common problem than previously thought. LEVEL OF EVIDENCE: 3.
Assuntos
Osteogênese/fisiologia , Próteses e Implantes , Costelas/cirurgia , Escoliose/cirurgia , Doenças Torácicas/cirurgia , Titânio , Análise de Variância , Criança , Seguimentos , Humanos , Modelos Logísticos , Radiografia , Insuficiência Respiratória/complicações , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/cirurgia , Estudos Retrospectivos , Costelas/anormalidades , Costelas/diagnóstico por imagem , Escoliose/complicações , Escoliose/fisiopatologia , Síndrome , Doenças Torácicas/complicações , Doenças Torácicas/fisiopatologia , Procedimentos Cirúrgicos Torácicos/métodos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Early onset scoliosis (EOS) is a potentially fatal, challenging group of diseases the management of which has markedly changed in the last decade. The purpose of this review is to provide the reader with a brief description of each of these new therapeutic modalities, their indications for use, and early clinical results. METHODS: A systematic review of peer-reviewed publications and abstracts related to the treatment of EOS in the last decade was carried out and synthesized into a review of modern treatment methods. RESULTS: Recent advances in techniques and understanding of preserving the thoracic space have improved the morbidity and mortality of children with progressive EOS. Derotational casting may be used in younger patients with curves between 25 and 60 degrees. The vertical expandable prosthetic titanium rib is best suited for patients with thoracic insufficiency syndrome. Single or dual growing rods may be used alone or in combination with vertical expandable prosthetic titanium rib to treat patients with progressive EOS who are not candidates for casting. Shilla technique is an alternative to growing rods that avoids the morbidity of repeated lengthenings but is not as well proven as the techniques described above. Other methods such as automatic growing rods and growth modulation techniques are still investigational, and their role needs to be defined after further study. CONCLUSIONS: Recent advances have improved the treatment of children with EOS. Treatment continues to be challenging with complication rates higher than treatment of idiopathic scoliosis. LEVEL OF EVIDENCE: Level V.
Assuntos
Procedimentos Ortopédicos/métodos , Escoliose/cirurgia , Doenças Torácicas/cirurgia , Idade de Início , Animais , Moldes Cirúrgicos , Criança , Progressão da Doença , Humanos , Próteses e Implantes , Costelas/cirurgia , Escoliose/fisiopatologia , Síndrome , Doenças Torácicas/fisiopatologia , Vértebras Torácicas , TitânioRESUMO
Cardiac herniation is a rare event associated with a high mortality rate. It is typically seen with blunt trauma to the chest or after a pneumectomy. Signs and symptoms include arrhythmia, myocardial ischemia, and hypotension. Diagnostic modalities, such as computed tomography scan, chest roentgenogram, magnetic resonance imaging, and transthoracic and transesophageal echocardiography, are key to diagnosis. Successful management requires timely recognition along with prompt surgical intervention.
Assuntos
Cateterismo Cardíaco/métodos , Aneurisma Cardíaco/diagnóstico , Hérnia/etiologia , Doenças Torácicas/cirurgia , Parede Torácica/cirurgia , Toracotomia/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/cirurgia , Diagnóstico por Imagem/métodos , Ecocardiografia Doppler/métodos , Seguimentos , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração/cirurgia , Hérnia/fisiopatologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Doenças Raras , Medição de Risco , Doenças Torácicas/etiologia , Doenças Torácicas/fisiopatologia , Toracotomia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
For 7 years videothoracoscopies for diseases and traumas of the chest were fulfilled in 2075 patients, abscessoscopy in 27 patients. Repeated videothoracoscopies were fulfilled in 41 (2%) patients operated for spontaneous pneumothorax, pleural empyema, exudative pleurisy and injuries to the chest due to recurrent hydropneumothorasx, prolonged abundant release by drainage, bleedings by drainage or formation of clotted hemothorax, not effectiveness of sanation, of the empyema cavity, reabscessoscopy - in 2 patients. Revideothoracoscopies were divided into groups with the presence of drainages or removed drainages according to the terms - into emergent (on the first day, immediately after the development of complications), urgent (from 2 to5 days), postponed (from 6 to 15 days), and late (more than 15 days). In 4 cases the conversion to minithoracotomy had to be done due to continuing bleeding, the absence of lung hermetism. All patients with spontaneous pneumothorax, pleuritis and chest trauma recovered. Lethal outcome was in 1 (2.4%) case from lung artery thromboembolism. It was concluded that revideothoracoscopy was an alternative thoracotomy of full value in reinterventions.
Assuntos
Doenças Torácicas/diagnóstico , Doenças Torácicas/cirurgia , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Cirurgia Torácica Vídeoassistida/normas , Drenagem/efeitos adversos , Feminino , Humanos , Hidropneumotórax/diagnóstico , Hidropneumotórax/etiologia , Hidropneumotórax/cirurgia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Cavidade Pleural/patologia , Cavidade Pleural/fisiopatologia , Cavidade Pleural/cirurgia , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/cirurgia , Recidiva , Reoperação , Doenças Torácicas/fisiopatologia , Traumatismos Torácicos/fisiopatologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Parede Torácica/patologia , Parede Torácica/fisiopatologia , Parede Torácica/cirurgiaRESUMO
Intrathoracic mass lesions, especially peripherally situated masses, often present as a problem as tissue diagnosis is not always possible by cytopathological examination. Cutting needle biopsy may be the method of choice in selected cases for tissue diagnosis. Cutting needle biopsy is indicated for patients with peripherally situated mass lesions abutting chest wall, which are non-vascular and non-cystic in nature.
Assuntos
Biópsia por Agulha/métodos , Neoplasias Torácicas/diagnóstico , Biópsia por Agulha/instrumentação , Estudos de Viabilidade , Humanos , Doenças Torácicas/diagnóstico , Doenças Torácicas/fisiopatologia , Neoplasias Torácicas/fisiopatologiaRESUMO
Catamenial pneumothorax is a rare entity of spontaneous, recurrent pneumothorax occurring in synchrony with the menstrual cycle. The etiology is not completely known, but in most cases it is associated with thoracic endometriosis and/or diaphragmatic fenestrations. We report a case of a 35-year-old woman with three episodes of catamenial pneumothorax. The surgical findings were thoracic endometriosis and diaphragmatic holes. She underwent resection of the affected part of the diaphragm and pleurodesis via a mini-thoracotomy and videothoracoscopy assistance.
Assuntos
Diafragma/patologia , Endometriose/diagnóstico , Menstruação , Pneumotórax/etiologia , Doenças Torácicas/diagnóstico , Adulto , Diafragma/cirurgia , Endometriose/complicações , Endometriose/fisiopatologia , Endometriose/cirurgia , Feminino , Humanos , Pneumotórax/fisiopatologia , Pneumotórax/cirurgia , Recidiva , Doenças Torácicas/complicações , Doenças Torácicas/fisiopatologia , Doenças Torácicas/cirurgia , Cirurgia Torácica Vídeoassistida , Toracotomia , Resultado do TratamentoRESUMO
Posterior correction and fusion with segmental hook instrumentation represent the gold standard in the surgical treatment of progressive idiopathic thoracic scoliosis. However, there is a debate over whether pedicle screws are safe in scoliosis surgery and whether their usage might enable a better curve correction and a shorter fusion length. The details of curve correction, fusion length and complication rate of 99 patients with idiopathic thoracic scoliosis treated with either hook or pedicle screw instrumentation were analyzed. Forty-nine patients had been operated with the Cotrel-Dubousset system using hooks exclusively ("hook group"). Fifty patients had been operated with either a combination of pedicle screws in the lumbar and lower thoracic and hooks in the upper thoracic spine or exclusive pedicle screw instrumentation using the Münster Posterior Double Rod System ("screw group"). The preoperative Cobb angle averaged 61.3 degrees (range 40 degrees-84 degrees ) in the hook group and 62.5 degrees (range 43 degrees-94 degrees ) in the screw group. Average primary curve correction was 51.7% in the hook group and 55.8% in the screw group ( P>0.05). However, at follow-up (2-12 years later) primary curve correction was significantly greater ( P=0.001) in the screw group (at 50.1%) compared to the hook group (at 41.1%). Secondary lumbar curve correction was significantly greater ( P=0.04) in the screw group (54.9%) compared to the hook group (46.9%). Correction of the apical vertebral rotation according to Perdriolle was minimal in both groups. Apical vertebral translation was corrected by 42.0% in the hook group and 55.6% in the screw group ( P=0.008). Correction of the tilt of the lowest instrumented vertebra averaged 48.1% in the hook group and 66.2% in the screw group ( P=0.0004). There were no differences concerning correction of the sagittal plane deformity between the two groups. Fusion length was, on average, 0.6 segments shorter in the screw group compared to the hook group ( P=0.03). With pedicle screws, the lowest instrumented vertebra was usually one below the lower end vertebra, whereas in the hook group it was between one and two vertebrae below the lower end vertebra. Both operative time and intraoperative blood loss were significantly higher in the hook group ( P<0.0001). One pedicle screw at T5 was exchanged due to the direct proximity to the aorta. There were no neurologic complications related to pedicle screw instrumentation. Pedicle screw instrumentation alone or in combination with proximal hook instrumentation offers a significantly better primary and secondary curve correction in idiopathic thoracic scoliosis and enables a significantly shorter fusion length.