Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.223
Filtrar
3.
Int Endod J ; 53(2): 186-199, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31162683

RESUMEN

AIM: To reach a consensus on a consistent strategy to adopt when screening patients for dental/periodontal infections and on the feasibility of providing dental treatment before cardiothoracic surgery, cardiovascular surgery or other cardiovascular invasive procedures. METHODOLOGY: A panel of experts from six Italian scientific societies was created. The deliberations of the panel were based on the RAND method. From an initial systematic literature review, it became clear that a consensually validated protocol for the reproducible dental screening of patients awaiting cardiac interventions was considered mandatory by professionals with expertise in the dental, cardiologic and cardiac surgery areas. However, a systematic review also concluded that the treatment options to be provided, their prognosis and timing in relation to the physical condition of patients, had never been defined. Following the systematic review, several fundamental questions were generated. The panel was divided into two working groups each of which produced documents that addressed the topic and which were subsequently used to generate a questionnaire. Each member of the panel completed the questionnaire independently, and then, a panel discussion was held to reach a consensus on how best to manage patients with dental/periodontal infections who were awaiting invasive cardiac procedures. RESULTS: A high level of agreement was reached regarding all the items on the questionnaire, and each of the clinical questions formulated were answered. Three tables were created which can be used to generate a useful tool to provide standardized dental/periodontal screening of patients undergoing elective cardiovascular interventions and to summarize both the possible oral and cardiovascular conditions of the patient and the timing available for the procedures considered. CONCLUSIONS: Upon publication of this consensus document, the dissemination of the information to a wide dental and cardiac audience should commence. The authors hope that this consensus will become a model for the development of a dedicated protocol, ideally usable by heart and dental teams in the pre-interventional preparation phase.


Asunto(s)
Procedimientos Quirúrgicos Cardiovasculares , Enfermedades Periodontales , Enfermedades Estomatognáticas , Procedimientos Quirúrgicos Torácicos , Consenso , Humanos , Enfermedades Periodontales/diagnóstico , Cuidados Preoperatorios , Enfermedades Estomatognáticas/diagnóstico
4.
Radiol Clin North Am ; 58(1): 133-150, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31731897

RESUMEN

Imaging plays a central role in the evaluation of patients following cardiothoracic surgery, both for monitoring in the early postoperative period and for assessing for suspected complications. Patients with postsurgical complications can develop a range of signs and symptoms, from hypotension and tachycardia, as the result of severe bleeding, to fever and leukocytosis because of infection. The radiologist is an important member of the care team in the postoperative period, helping identify and manage complications of cardiothoracic surgery. This article reviews the common complications of cardiothoracic surgery focusing on the role of imaging and clues to diagnosis.


Asunto(s)
Cardiopatías/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Enfermedades Respiratorias/diagnóstico por imagen , Procedimientos Quirúrgicos Torácicos/efectos adversos , Tomografía Computarizada por Rayos X/métodos , Enfermedades Vasculares/diagnóstico por imagen , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Cardiopatías/etiología , Humanos , Complicaciones Posoperatorias/etiología , Radiografía/métodos , Enfermedades Respiratorias/etiología , Enfermedades Vasculares/etiología
5.
Kyobu Geka ; 72(10): 816-820, 2019 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-31582702

RESUMEN

Locally advanced lung cancer invading central bronchi, carina, and trachea can be resected with bronchoplastic techniques including sleeve lobectomy and sleeve pneumonectomy. These procedures can be performed on selected patients with advanced lung cancer invading the root of lobar bronchus or carina. After the bronchial/tracheal resection, anastomosis of the severed bronchus/trachea is done to reconstruct the airway. The anastomosis should be done with great care, avoiding postoperative dehiscence, stenosis, or granulation formation. Some tips and pitfalls of the procedures, including determination of the bronchial cutting line, detail of the suturing, methods for bronchial mobilization, and anastomotic coverage are described. Guidelines in our country or oversees recommend that lung-sparing anatomic resection (sleeve lobectomy) may be preferred over pneumonectomy for cardiopulmonary reserve of the patient.


Asunto(s)
Neoplasias Pulmonares , Procedimientos Quirúrgicos Reconstructivos , Procedimientos Quirúrgicos Torácicos , Bronquios , Humanos , Neumonectomía , Tráquea
6.
Orv Hetil ; 160(42): 1655-1662, 2019 Oct.
Artículo en Húngaro | MEDLINE | ID: mdl-31608689

RESUMEN

Introduction: Most modern thoracic operations are performed with single-lung ventilation balancing between convenient surgical approach and adequate gas exchange. The technical limitations include difficult airways or insufficient parenchyma for the intraoperative single-lung ventilation. Earlier, cardiopulmonary bypass was the only solution, however, today the extracorporeal membrane oxygenation is in the forefront. Aim: We retrospectively analysed our elective operations by use of venovenous ECMO to assess the indication, safety, perioperative morbidity and mortality. Patients and method: 12 patients were operated using venovenous (VV-) ECMO between 28 April 2014 and 30 April 2018 in the National Institute of Oncology. The main clinicopathological characteristics, data regarding the operation, the use of ECMO and survival were collected. Results: The mean age was 45 years, 2 patients had benign and 10 had malignant diseases. Extreme tracheal stricture was the indication for ECMO in 3 cases, while 4 patients had previous lung resection and lacked enough parenchyma for single-lung ventilation. 5 patients had both airway and parenchymal insufficiency. The average time of apnoea was 142 minutes without interruption in any of the cases. We did not experience any ECMO-related complication. We had no intraoperative death and 30-day mortality was 8.33%. Conclusion: In case of technical inoperability, when there is no airway or insufficient parenchyma for gas exchange, but pulmonary vascular bed is enough and there is no need for great-vessel resection, VV-ECMO can safely replace the complete gas exchange without further risk of bleeding. The use of VV-ECMO did not increase the perioperative morbidity and mortality. Previously inoperable patients can be operated with VV-ECMO. Orv Hetil. 2019; 160(42): 1655-1662.


Asunto(s)
Obstrucción de las Vías Aéreas/terapia , Oxigenación por Membrana Extracorpórea/métodos , Cirugía Torácica/métodos , Procedimientos Quirúrgicos Torácicos/métodos , Adulto , Anciano , Obstrucción de las Vías Aéreas/etiología , Oxigenación por Membrana Extracorpórea/efectos adversos , Femenino , Humanos , Hungría , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Torácicos/efectos adversos , Resultado del Tratamiento
8.
Medicine (Baltimore) ; 98(41): e17387, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31593088

RESUMEN

BACKGROUND: Double-lumen bronchial tubes (DLBT) and bronchial blockers (BB) are commonly used in the anesthesia for clinical thoracic surgery. But there are few systematic clinical comparisons between them. In this study, the effects of BB and DLBT on one-lung ventilation (OLV) are studied. METHODS: The 200 patients with thoracic tuberculosis undergoing thoracic surgery, were randomly assigned to group A (DLBT) and group B (BB). Intubation time, hemodynamic changes (mean arterial pressure [MAP], heart rate [HR]), and arterial blood gas indicators (arterial partial pressure of carbon dioxide [PaCO2], arterial partial pressure of oxygen [PaO2], airway plateau pressure [Pplat], and airway peak pressure [Ppeak]) at 4 time points were recorded. Complications such as hoarseness, pulmonary infection, pharyngalgia, and surgical success rate were also evaluated postoperatively. RESULTS: Intubation times were shorter in group B. Both MAP and HR in group A were significantly higher 1 minute after intubation than before, but also higher than those in group B. PaO2 levels were lower in both groups during (OLV) than immediately after anesthesia and after two-lung ventilation (TLV), with PaO2 being lower after 60 minutes of OLV than after 20 minutes of OLV. Furthermore, at both points during OLV, PaO2 was lower in group A than in group B. No significant differences in PaCO2 were found between the 2 groups. Ppeak and Pplat were increased in both groups during OLV, with both being higher in group A than in group B. The incidence of postoperative hoarseness, pulmonary infection, and pharyngalgia were lower in group B. There was no significant difference in the success rate of operation between the 2 groups. CONCLUSIONS: Compare with using DLBT, implementation of BB in general anesthesia has less impact on hemodynamics, PaO2 and airway pressures, and achieves lower incidence of postoperative complication.


Asunto(s)
Anestesia General/métodos , Broncoconstrictores/administración & dosificación , Ventilación Unipulmonar/métodos , Procedimientos Quirúrgicos Torácicos/métodos , Tuberculosis Pulmonar/cirugía , Anciano , Femenino , Hemodinámica , Humanos , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Presión Parcial
10.
J Surg Oncol ; 120(7): 1235-1240, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31536137

RESUMEN

BACKGROUND: Primary soft tissue sarcomas (STSs) involving the chest wall are uncommon. The aim of this study was to identify factors that influence the prognosis of patients with primary chest wall STS. METHODS: The records of 38 patients (23 men and 15 women) who were treated at our institutions during 2002 to 2018 were reviewed. The following variables were evaluated as potential prognostic factors: sex, tumor size, chemotherapy, and completeness of surgical margins. Multivariate analysis was conducted to identify predictors of overall survival (OS) and disease-free survival (DFS). RESULTS: Of the 38 included patients, 5 had low-grade tumors and 33 had high-grade tumors. Five patients required chest wall reconstruction including rib resection. Thirty patients (79%) underwent R0 resection. The 5-year OS and DFS rates were 45% and 27%, respectively. Local recurrence developed in 7 patients. Multivariate analysis identified tumor size (hazard ratio [HR]: 4.13; 95% confidence interval [CI]: 1.05-16.24; P = .04) and R1/2 resection (HR: 3.92; 95% CI: 1.12-13.66; P = .03) as predictors of OS. CONCLUSIONS: Prognostic factors for survival included tumor size and completeness of surgical margins. Complete tumor excision is desirable, particularly in cases of early detection.


Asunto(s)
Sarcoma/mortalidad , Procedimientos Quirúrgicos Torácicos/mortalidad , Pared Torácica/cirugía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Sarcoma/patología , Sarcoma/terapia , Tasa de Supervivencia , Pared Torácica/patología
12.
Artículo en Inglés | MEDLINE | ID: mdl-31497937

RESUMEN

A 61-year-old male who lived for 30 years in a rural area presented chest pain of 3 months duration. Multiple hydatid cysts (Echinococcus granulosus) were diagnosed in the pericardium and the mediastinum by echocardiography and computed tomography. The cysts were removed successfully with the patient on cardiopulmonary bypass and beating heart.  This video tutorial shows how we removed the cysts, using the puncture-aspiration and enucleation technique.  Few videos of this technique exist, and we believe that this tutorial is a helpful demonstration of how to handle mediastinal and pericardial hydatid cysts.


Asunto(s)
Equinococosis/cirugía , Cardiopatías/cirugía , Enfermedades del Mediastino/cirugía , Procedimientos Quirúrgicos Torácicos/métodos , Equinococosis/diagnóstico , Equinococosis/parasitología , Ecocardiografía , Cardiopatías/diagnóstico , Cardiopatías/parasitología , Humanos , Masculino , Enfermedades del Mediastino/diagnóstico , Enfermedades del Mediastino/parasitología , Mediastino , Persona de Mediana Edad , Pericardio , Tomografía Computarizada por Rayos X
13.
Zentralbl Chir ; 144(S 01): S46-S56, 2019 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-31484205

RESUMEN

Human echinococcosis is a rare zoonotic infection caused by larvae of the tapeworm species Echinococcus. The most relevant two species to humans are Echinococcus multilocularis and the dog tapeworm Echinococcus granulosus. The latter causes cystic echinococcosis, which plays a dominant role in thoracic surgery due to its pulmonal involvement. The parasite develops characteristic hydatic cysts mostly in liver and lung. In 2016 a rise in cases of cystic echinococcosis in Germany was recorded, a probable cause could have been the refugee wave. The infection and advanced stages of the disease does not always cause symptoms and stays asymptomatic. Dry cough, thoracic pain and hemoptysis are uncharacteristic symptoms. Cysts may rupture and void into the bronchial system or thoracic cavity, which can result in empyema. Surgery remains the main therapeutic approach for pulmonary cystic echinococcosis. Surgical therapy includes peri- or endocystectomy, wedge and anatomic resections. Depending on size and localization of hydatid cysts the appropriate surgical technique should be chosen aiming on minimal loss of lung parenchyma. The treatment strategies need to be discussed in an interdisciplinary setting including infectiologists and thoracic or general surgeons. The respective treatment should be carried out in specialized centers due to the low incidence of the disease.


Asunto(s)
Equinococosis Pulmonar , Echinococcus granulosus , Procedimientos Quirúrgicos Torácicos , Animales , Perros , Equinococosis Pulmonar/cirugía , Alemania , Humanos
15.
Ann Thorac Surg ; 108(4): 1107-1113, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31447051

RESUMEN

BACKGROUND: New persistent opioid use occurs in 3% to 14% of patients after elective surgery, but is poorly described after cardiothoracic surgery. We examined the association of prescription size with new persistent opioid use after cardiothoracic surgery. METHODS: Opioid-naive Medicare patients undergoing cardiothoracic surgery between 2009 and 2015 were identified. Patients who filled an opioid prescription between 30 days before surgery and 14 days after discharge and with continuous Medicare enrollment 12 months before and 6 months after surgery were selected (n = 24,549). New persistent use was defined as continued prescription fills 91 to 180 days after surgery. Prescription size was reported in oral morphine equivalents. Multivariable regression was performed for risk adjustment, and new persistent use rate was estimated. RESULTS: Patient age was 71 ± 8 years, 9222 (38%) were female, and 20,898 (85%) were white. Overall new persistent use was 12.8% (3153 of 24,549), and declined yearly from 17% in 2009 to 7.1% in 2015 (P < .001). Prescription size, preoperative prescription fills, black race, gastrointestinal complications, disability status, open lung resection, dual eligibility (Medicare and Medicaid), drug and substance abuse, female sex, tobacco use, high comorbidity, pain disorders, longer hospital stay, and younger age were associated with new persistent use. Adjusted new persistent use was 19.6% (95% confidence interval, 18.7% to 20.4%) among patients prescribed more than 450 oral morphine equivalents, compared with 10.4% (95% confidence interval, 9.9% to 10.8%) among those prescribed 200 oral morphine equivalents or less (P < .001). CONCLUSIONS: Size and timing of perioperative opioid prescriptions were the strongest predictors of new persistent opioid use after cardiothoracic surgery. Modifiable risk factors such as prescription size should be targeted to reduce new persistent use.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina , Procedimientos Quirúrgicos Torácicos/efectos adversos , Anciano , Prescripciones de Medicamentos , Femenino , Humanos , Masculino , Medicare , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Estados Unidos
16.
17.
Am J Case Rep ; 20: 998-1001, 2019 Jul 11.
Artículo en Inglés | MEDLINE | ID: mdl-31292431

RESUMEN

BACKGROUND It is very challenging for anesthesiologists to manage patients with pulmonary hypertension undergoing general anesthesia for elective or emergent surgeries. CASE REPORT We present a patient with severe pulmonary hypertension going through a major robotic thoracic surgery. CONCLUSIONS A goal-directed anesthesia management algorithm based on serial stroke volume (SV) values obtained from FloTrac (Edwards Lifesciences, LLC.) minimally invasive arterial pressure sensor was utilized in an attempt to reduce the anesthetic and surgical risk associated with severe pulmonary hypertension.


Asunto(s)
Anestesia General , Tratamiento Precoz Dirigido por Objetivos , Hipertensión Pulmonar/complicaciones , Neoplasias Pulmonares/cirugía , Monitoreo Intraoperatorio , Anciano , Femenino , Humanos , Procedimientos Quirúrgicos Torácicos
18.
Kyobu Geka ; 72(6): 407-411, 2019 Jun.
Artículo en Japonés | MEDLINE | ID: mdl-31268011

RESUMEN

The purpose of this study is to evaluate the safety and the efficacy of preoperative oral rehydration therapy comparison with infusion therapy in thoracic surgery. Eighty-four patients scheduled for thoracic surgery were assigned to an oral rehydration group or an infusion group. We checked the amount of their urine and performed blood and urine test. And we carried out questionnaire concerning preoperative therapies to these patients. No morbidity concerned with preoperative therapies was encountered. There was no significant difference in blood and urine test in 2 groups. The answer of questionnaire showed more difficulties in the preoperative period in the infusion therapy group. Present study showed that the preoperative oral rehydration therapy could be done as safely as the infusion therapy with less difficulties compared to the infusion therapy even in the field of thoracic surgery.


Asunto(s)
Procedimientos Quirúrgicos Torácicos , Fluidoterapia , Humanos , Periodo Preoperatorio
20.
Medicine (Baltimore) ; 98(30): e16564, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31348281

RESUMEN

RATIONALE: Neuroblastoma is one of the most common malignant tumors in childhood, which mainly occurs in adrenal glands and peripheral sympathetic nerve system. Neuroblastoma occurring in adulthood is rare, and adults with neuroblastoma arising from thorax are exceedingly rare. A case of neuroblastoma that originated from thorax was reported, and was treated by resection operation. PATIENT CONCERNS: A 46-year-old woman was admitted to our hospital with left side chest pain for 5 days. Laboratory examinations were all normal. Chest computerized tomogram (CT) showed a lesion with clear boundary that was located at the left dorsal pleura. The nature of the mass was heterogeneous, showing slight heterogeneous enhancement after contrast and there was no obvious necrosis. DIAGNOSES: Based on the morphologic and immunohistochemical features, the tumor diagnosis was favorable for neuroblastoma. INTERVENTIONS: A resection operation was carried out. OUTCOMES: Three years postoperative, no sign of recurrence or metastasis has been observed. LESSONS: Primary neuroblastoma in adulthood is rare and has poor prognosis. Resection can be an important treatment option, and combining with other methods like chemotherapy, stem cell transplantation, the survival rate may be improved.


Asunto(s)
Neuroblastoma/cirugía , Neoplasias Torácicas/cirugía , Femenino , Humanos , Persona de Mediana Edad , Neuroblastoma/patología , Neoplasias Torácicas/patología , Procedimientos Quirúrgicos Torácicos/métodos , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA