RESUMO
INTRODUCTION: Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the joints but which frequently includes extra articular effects, including pulmonary nodules, which grow faster under immunosuppressive treatment. CASE REPORT: A 74 years old man, with mild asbestosis, underwent treatment with methotrexate then leflunomide (LEF) for seropositive RA. In February 2014, during monitoring of his asbestosis, chest CT scan showed the appearance of thick-walled cavitating lung nodules, with a central and sub pleural distribution. The patient was asymptomatic. Bronchoalveolar lavage excluded infection and tumor. LEF was stopped but in May 2014, the patient was admitted with respiratory infection and a pyopneumothorax which required surgical management. The postoperative course was complicated with a persistent pneumothorax. CONCLUSIONS: We describe a case of RA complicated by a pyopneumothorax after treatment with LEF. The risk of this complication could be reduced by regular chest imaging.
Assuntos
Artrite Reumatoide/complicações , Pneumotórax/etiologia , Idoso , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/cirurgia , Asbestose/complicações , Asbestose/diagnóstico , Asbestose/cirurgia , Diagnóstico Diferencial , Empiema Pleural/diagnóstico , Empiema Pleural/etiologia , Empiema Pleural/cirurgia , Humanos , Masculino , Nódulos Pulmonares Múltiplos/diagnóstico , Nódulos Pulmonares Múltiplos/cirurgia , Pneumotórax/diagnóstico , Pneumotórax/cirurgiaRESUMO
INTRODUCTION: Pectus deformities are the most frequently seen congenital thoracic wall anomalies. The cause of these conditions is thought to be abnormal elongation of the rib cartilages. We here report our clinical experience and the results of a sternochondroplasty procedure based on the subperichondrial resection of the elongated cartilages. HYPOTHESIS: This technique is a valuable surgical strategy to treat the wide variety of pectus deformities. PATIENTS AND METHODS: During the period from October 2001 through September 2009, 205 adult patients (171 men and 34 women) underwent pectus excavatum (181), carinatum (19) or arcuatum (5) repair. The patients' pre and postoperative data were collected using a computerized database, and the results were assessed with a minimum 2-year follow-up. RESULTS: The postoperative morbidity rate was minimal and the mortality was nil. The surgeon graded cosmetic results as excellent (72.5%), good (25%) or fair (2.5%), while patients reported better results. Patients with pectus excavatum were found to have much more patent foramen ovale (PFO) than the normal adult population, which occluded after the procedure in 61% of patients, and significant improvement was found in exercise cardiopulmonary function and exercise tolerance at the 1-year follow-up. DISCUSSION: Our sternochondroplasty technique based on the subperichondrial resection of the elongated cartilages allows satisfactory repair of both pectus excavatum and sternal prominence. It is a safe procedure that might improve the effectiveness of surgical therapy in patients with pectus deformities.
Assuntos
Tórax em Funil/cirurgia , Parede Torácica/anormalidades , Parede Torácica/cirurgia , Toracoplastia/métodos , Adolescente , Adulto , Cartilagem/anormalidades , Cartilagem/diagnóstico por imagem , Cartilagem/cirurgia , Feminino , Seguimentos , Tórax em Funil/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Costelas/anormalidades , Costelas/diagnóstico por imagem , Costelas/cirurgia , Esterno/anormalidades , Esterno/diagnóstico por imagem , Esterno/cirurgia , Parede Torácica/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemAssuntos
Neoplasias Pulmonares/complicações , Células Neoplásicas Circulantes/patologia , Artéria Pulmonar/patologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/patologia , Neoplasias da Glândula Tireoide/complicações , Biópsia por Agulha Fina , Feminino , Humanos , Pessoa de Meia-Idade , Pneumonectomia , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Radiografia , Sensibilidade e Especificidade , UltrassonografiaAssuntos
Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/cirurgia , Endoscopia , Excisão de Linfonodo , Adolescente , Adulto , Idoso , Neoplasias Brônquicas/classificação , Tumor Carcinoide/classificação , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Organização Mundial da SaúdeRESUMO
INTRODUCTION: Pectus excavatum or funnel chest is the most common anterior chest wall deformity seen in children and adults. The sternal depression appears to be caused by overgrowth of the costal cartilages, also the cause of the less common deformities: pectus carinatum (pigeon breast) and pectus arcuatum. BACKGROUND: Usually the overgrowth involves the third to seventh costal cartilages but it can be more or less extensive. The cardiopulmonary functional consequences are insignificant in the protrusional deformities and inconsistent in pectus excavatum and the indications for surgery are mainly cosmetic. VIEWPOINT AND CONCLUSIONS: The procedural modalities are guided by morphological study of the CT scan. We describe a surgical technique that comprise subperichondrial excision of all deformed costal cartilages followed by transverse sternotomy to correct the sternal deformity, anteriorly in the case of pectus excavatum and posteriorly for pectus carinatum and arcuatum. As the perichondrial sheaths are totally preserved they are sutured in continuous layers to give a shortening effect. In the case of pectus excavatum the sternum is then secured anteriorly for about 6 months by a retrosternal metallic strut in an overcorrected position. The partially resected seventh cartilages are then sutured to the xiphoid. Other surgical techniques are described, including modified Ravitch's procedure, modelling osteochondroplasty, prosthetic reconstruction and Nuss's procedure. Results of the more important series are reported and discussed.