A female newborn presented with respiratory distress at birth and was diagnosed with congenital tracheal stenosis. The stenosis was positioned at the distal trachea and compromised the carina and the right and left bronchi. She underwent surgical treatment using circulatory life support with veno-arterial peripheral extracorporeal membrane oxygenation, and the airway was reconstructed using the slide tracheoplasty technique to build a neocarina. The patient had an excellent postoperative course, was successfully weaned from extracorporeal membrane oxygenation and invasive ventilation, and was discharged.
Bronchi , Extracorporeal Membrane Oxygenation , Plastic Surgery Procedures , Trachea , Tracheal Stenosis , Humans , Female , Tracheal Stenosis/surgery , Tracheal Stenosis/congenital , Tracheal Stenosis/diagnostic imaging , Infant, Newborn , Trachea/surgery , Trachea/abnormalities , Trachea/diagnostic imaging , Extracorporeal Membrane Oxygenation/methods , Bronchi/surgery , Bronchi/abnormalities , Bronchi/diagnostic imaging , Plastic Surgery Procedures/methods , Treatment Outcome
Lung transplantation is a globally accepted treatment for some advanced lung diseases, giving the recipients longer survival and better quality of life. Since the first transplant successfully performed in 1983, more than 40 thousand transplants have been performed worldwide. Of these, about seven hundred were in Brazil. However, survival of the transplant is less than desired, with a high mortality rate related to primary graft dysfunction, infection, and chronic graft dysfunction, particularly in the form of bronchiolitis obliterans syndrome. New technologies have been developed to improve the various stages of lung transplant. To increase the supply of lungs, ex vivo lung reconditioning has been used in some countries, including Brazil. For advanced life support in the perioperative period, extracorporeal membrane oxygenation and hemodynamic support equipment have been used as a bridge to transplant in critically ill patients on the waiting list, and to keep patients alive until resolution of the primary dysfunction after graft transplant. There are patients requiring lung transplant in Brazil who do not even come to the point of being referred to a transplant center because there are only seven such centers active in the country. It is urgent to create new centers capable of performing lung transplantation to provide patients with some advanced forms of lung disease a chance to live longer and with better quality of life.
Idiopathic Pulmonary Fibrosis/surgery , Lung Transplantation/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/surgery , Age Factors , Brazil , Cause of Death , Contraindications , Donor Selection , Graft Rejection/prevention & control , Humans , Lung Transplantation/methods , Lung Transplantation/mortality , Perioperative Period , Risk Assessment , Survival Analysis , Waiting Lists
ABSTRACT Lung transplantation is a globally accepted treatment for some advanced lung diseases, giving the recipients longer survival and better quality of life. Since the first transplant successfully performed in 1983, more than 40 thousand transplants have been performed worldwide. Of these, about seven hundred were in Brazil. However, survival of the transplant is less than desired, with a high mortality rate related to primary graft dysfunction, infection, and chronic graft dysfunction, particularly in the form of bronchiolitis obliterans syndrome. New technologies have been developed to improve the various stages of lung transplant. To increase the supply of lungs, ex vivo lung reconditioning has been used in some countries, including Brazil. For advanced life support in the perioperative period, extracorporeal membrane oxygenation and hemodynamic support equipment have been used as a bridge to transplant in critically ill patients on the waiting list, and to keep patients alive until resolution of the primary dysfunction after graft transplant. There are patients requiring lung transplant in Brazil who do not even come to the point of being referred to a transplant center because there are only seven such centers active in the country. It is urgent to create new centers capable of performing lung transplantation to provide patients with some advanced forms of lung disease a chance to live longer and with better quality of life.
RESUMO O transplante pulmonar é um tratamento mundialmente aceito para alguma pneumopatias avançadas, conferindo aos receptores maior sobrevida e melhor qualidade de vida. Desde o primeiro transplante realizado com sucesso em 1983, mais de 40 mil transplantes foram feitos em todo mundo. Destes, cerca de 700 foram no Brasil. No entanto, a sobrevida do transplante é menor do que a desejada, com altos índices de mortalidade relacionados à disfunção primária do enxerto, infecções e disfunção crônica do enxerto, principalmente sob a forma da síndrome da bronquiolite obliterante. Novas tecnologias têm sido desenvolvidas para aprimoramento das diversas etapas do transplante pulmonar. Para aumentar a oferta de pulmões, o recondicionamento pulmonar ex vivo vem sendo utilizado em alguns países, inclusive no Brasil. Para suporte avançado de vida no período perioperatório, equipamentos de oxigenação extracorpórea e de suporte hemodinâmico vêm sendo utilizado como ponte para o transplante em pacientes gravemente doentes em lista de espera e para manter pacientes vivos até a resolução da disfunção primária do enxerto pós-transplante. Existe uma demanda reprimida de pacientes que necessitam de transplante pulmonar no Brasil e que nem sequer chegam a ser encaminhados a um centro transplantador, pois só existem sete deles ativos no país. É urgente a criação de novos centros capazes de realizar transplante pulmonar para oferecer a pacientes com algumas pneumopatias avançadas uma chance de viver mais e com melhor qualidade de vida.
Humans , Lung Transplantation/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/surgery , Idiopathic Pulmonary Fibrosis/surgery , Brazil , Survival Analysis , Cause of Death , Waiting Lists , Age Factors , Lung Transplantation/methods , Lung Transplantation/mortality , Risk Assessment , Donor Selection , Perioperative Period , Contraindications , Graft Rejection/prevention & control
Small animal models are particularly suitable for lung preservation studies, because they are simple and cost-effective. This brief communication focuses on the technical description of an ex vivo lung perfusion model in rats by means of a commercially available apparatus, which was the first to be installed in a thoracic surgery research laboratory in Brazil. The model and its preparation, together with its applications for lung preservation studies, are described in detail. All technical details can also be seen in a video posted on the website of the Brazilian Journal of Pulmonology.
Lung , Organ Preservation/methods , Perfusion/methods , Animals , Lung Transplantation , Male , Random Allocation , Rats
Estudos de preservação pulmonar em modelos experimentais realizados em animais de pequeno porte são de realização mais simples e barata. Esta comunicação tem o enfoque de descrever tecnicamente um modelo de perfusão pulmonar ex vivo em ratos, com o uso de um equipamento disponível comercialmente que foi o primeiro a ser instalado em um laboratório de pesquisa em cirurgia torácica no Brasil. Descrevemos detalhadamente o modelo e sua preparação, assim como suas aplicações para estudos de preservação pulmonar. Os detalhes técnicos da preparação podem ser observados também em um vídeo postado no site do Jornal Brasileiro de Pneumologia.
Small animal models are particularly suitable for lung preservation studies, because they are simple and cost-effective. This brief communication focuses on the technical description of an ex vivo lung perfusion model in rats by means of a commercially available apparatus, which was the first to be installed in a thoracic surgery research laboratory in Brazil. The model and its preparation, together with its applications for lung preservation studies, are described in detail. All technical details can also be seen in a video posted on the website of the Brazilian Journal of Pulmonology.
Animals , Male , Rats , Lung , Organ Preservation/methods , Perfusion/methods , Lung Transplantation , Random Allocation
We present a case of the successful repair of an iatrogenic central vein lesion using a videothoracoscopic approach. The confluence of the right innominate vein and the superior vena cava was perforated during the placement of a right internal jugular vein long-term dialysis catheter. The misplacement of the tips of the catheter in the right pleural space was promptly observed. The catheter was removed under pleural videothoracoscopic vision while a tamponade was directly applied to the mediastinal perforation. Massive bleeding was prevented and the central vein perforation was treated successfully using a minimally invasive technique.
Brachiocephalic Veins/surgery , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Hemorrhage/surgery , Hemostatic Techniques , Renal Dialysis , Thoracic Surgery, Video-Assisted , Vena Cava, Superior/surgery , Wounds, Penetrating/surgery , Brachiocephalic Veins/injuries , Catheterization, Central Venous/instrumentation , Hemorrhage/etiology , Humans , Iatrogenic Disease , Male , Middle Aged , Polycystic Kidney Diseases/complications , Polycystic Kidney Diseases/therapy , Renal Insufficiency/etiology , Renal Insufficiency/therapy , Rupture , Treatment Outcome , Vena Cava, Superior/injuries , Wounds, Penetrating/etiology
In the last 20 years, lung transplantation has become the standard treatment for patients with end-stage lung disease. However, less than 20% of the donor lungs available for transplant are actually usable. This disparity between the growing number of recipients and the small number of donors has resulted in increased mortality among lung transplant candidates on waiting lists. Strategies such as the utilization of organs from marginal donors have proven ineffective in increasing the number of transplants. In 2000, a new method for reconditioning human lungs that had been previously rejected for transplantation was developed in Sweden. We describe our initial experience with ex vivo lung perfusion.
Lung Transplantation , Lung , Organ Preservation/methods , Perfusion/methods , Aged , Brazil , Donor Selection , Humans , Middle Aged , Perfusion/instrumentation
Nos últimos 20 anos, o transplante pulmonar tornou-se o tratamento padrão para algumas pneumopatias graves em estágio terminal. Menos de 20 por cento dos pulmões doados para transplante são realmente utilizados. Essa desproporção entre o crescente número de candidatos ao transplante pulmonar e o reduzido número de doadores resulta em aumento da mortalidade nas filas de espera. Estratégias, como o uso de órgãos de doadores marginais, não se mostraram efetivas em aumentar o número de transplantes. Em 2000, na Suécia, foi desenvolvido um método novo para recondicionar pulmões humanos rejeitados para transplante. Descrevemos nossa experiência inicial com a perfusão pulmonar ex vivo.
In the last 20 years, lung transplantation has become the standard treatment for patients with end-stage lung disease. However, less than 20 percent of the donor lungs available for transplant are actually usable. This disparity between the growing number of recipients and the small number of donors has resulted in increased mortality among lung transplant candidates on waiting lists. Strategies such as the utilization of organs from marginal donors have proven ineffective in increasing the number of transplants. In 2000, a new method for reconditioning human lungs that had been previously rejected for transplantation was developed in Sweden. We describe our initial experience with ex vivo lung perfusion.
Aged , Humans , Middle Aged , Lung , Lung Transplantation , Organ Preservation/methods , Perfusion/methods , Brazil , Donor Selection , Perfusion/instrumentation
RFC, mulher de 85 anos com desconforto em hemitórax direito. Atomografia de tórax na admissão demonstrou derrame pleural diretoe a videotoracoscopia identificou hematomas traumáticos semoutras lesões. O trauma é um diagnóstico diferencial de derramespleurais eosinofílicos. A videotoracoscopia tem sido preconizadacomo procedimento de escolha para diagnósticos diferenciais emderrames pleurais.
Humans , Female , Aged, 80 and over , Diagnosis, Differential , Hematoma , Pleural Effusion , Pulmonary Eosinophilia , Thoracic Surgery, Video-Assisted
BACKGROUND: Thoracic sympathectomy is indicated to treat primary hyperhidrosis. The objective is to analyze the results and complications of thoracic sympathectomy and propose a questionnaire to assess the quality of life of patients. METHODS: Between October 1995 and March 2002, 378 patients were evaluated. Sixty-two percent were female, with a mean age of 26.8 years old (range 9 to 70 years old). There were 57.4% patients with palmar-plantar hyperhidrosis; 25% with palmar, plantar, and axillary hyperhidrosis; 15.7% with pure axillary hyperhidrosis; and 6.5% with craniofacial hyperhidrosis. General anesthesia was used in 97.3%, epidural with sedation in 2.7%. The sympathetic chain was resected in 12.5%, thermal ablation with the electrical scalpel was performed in 66.3%, and with the harmonic scalpel in 21.2% of the patients. RESULTS: Successful sympathectomies were performed in 90.3% of the patients; the follow-up was from 1 to 60 months (mean 12.4 +/- 8.3 months). The recurrence rates were 8.2% for palmar hyperhidrosis, 13.7% for pure axillary hyperhidrosis, 27.5% of which were reoperated successfully. Improvement of the plantar hyperhidrosis was also registered in 58%. Horner's syndrome was reported in 1% with regression in half of them after 30 days. No mortality or serious complications were observed, nor the need to convert to thoracotomy. Of the total number of patients, 93.4% answered the quality of life questionnaire, 86.4% of whom noted improvement after the procedure. CONCLUSIONS: Thoracic sympathectomy is a simple, effective, safe method for the treatment of hyperhidrosis, resulting in an improved quality of life for patients. The questionnaire documents this change.
Quality of Life , Surveys and Questionnaires , Sympathectomy/methods , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Prospective Studies
BACKGROUND: Hyperhidrosis or excessive sudoresis is a chronic disease associated with important subjective distress. OBJECTIVE: To propose a specific questionnaire to evaluate the quality of life of patients with hyperhidrosis. METHODS: From October 1995 to March 2002, 378 patients (234 females), with a mean age of 26.8 years, were evaluated before and after video-assisted thoracic sympathectomy. RESULTS: Therapeutic success was obtained in 90 percent of the procedures. The recurrence rate was 10 percent for palmar and 11 percent for axillary hyperhidrosis; 27 percent of the patients who had recurrence were re-operated successfully. No serious complications were reported. Of the total number of patients, 91 percent answered to the quality of life questionnaire, and 86 percent of them reported improvement after the procedure. CONCLUSIONS: Thoracic sympathectomy is a therapeutic method capable of changing the quality of life of patients with hyperhidrosis. The questionnaire applied has shown these changes.
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Hyperhidrosis , Thoracic Surgical Procedures/methods , Quality of Life , Sympathectomy , Surveys and Questionnaires , Treatment Outcome
