Assuntos
Fixação de Fratura/métodos , Lesão Pulmonar/cirurgia , Tratamentos com Preservação do Órgão/métodos , Fraturas das Costelas/terapia , Ruptura/cirurgia , Acidentes de Trânsito , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Lesão Pulmonar/diagnóstico , Lesão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Fraturas das Costelas/complicações , Ruptura/diagnóstico , Ruptura/etiologia , Resultado do TratamentoRESUMO
OBJECTIVES: Treatment of refractory hepatic hydrothorax, a complication of liver cirrhosis, is complex. We aimed to investigate the usefulness of the '4-step approach', which is a minimally invasive surgical strategy combining 4 therapeutic modalities: (i) pneumoperitoneum to localize diaphragmatic defects; (ii) thoracoscopic pleurodesis; (iii) postoperative positive-pressure ventilation; and (iv) peritoneal drainage for abdominal decompression. METHODS: We retrospectively analysed the medical records of 12 patients with hepatic hydrothorax who underwent surgical treatment using the 4-step approach from January 2013 to December 2017. Nine of them (75.0%) were Child C cases; the median model for end-stage liver disease score was 20.5. The diaphragmatic defects localized after forming a pneumoperitoneum were treated with primary closure followed by thoracoscopic pleurodesis, postoperative positive-pressure ventilation and peritoneal drainage. RESULTS: Diaphragmatic defects were localized in all patients except one. The median postoperative positive-pressure ventilation duration was 20.1 h. Peritoneal drainage was performed for a median duration of 5 days; the peritoneal drains were removed at a median of 8 postoperative days. The median duration of postoperative hospital stay until discharge/transfer was 9.5 days. No operative mortalities occurred. The median duration of follow-up was 10.9 months. Eight deaths (66.7%) occurred during the follow-up period; however, no deaths were surgery-associated. Ipsilateral pleural effusion recurred in 3 patients (25%), among whom reoperation was performed in 1 without recurrence at the 13-month follow-up. CONCLUSIONS: The 4-step approach seems to be a safe and effective minimally invasive surgical strategy for treating refractory hepatic hydrothorax.
Assuntos
Doença Hepática Terminal , Hidrotórax , Criança , Humanos , Hidrotórax/diagnóstico por imagem , Hidrotórax/etiologia , Hidrotórax/cirurgia , Cirrose Hepática/complicações , Pleurodese , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: We conducted an observational study to evaluate the relationship between activated clotting time (ACT) and activated partial thromboplastin time (aPTT) tests, anticipating the possibility that the ACT will become a substitute test for the aPTT in post-CPR extracorporeal membrane oxygenation (e-CPR). PATIENTS AND METHODS: Three hundred and fifteen paired ACT and aPTT samples were derived from 60 in-hospital e-CPR patients and were divided into three groups according to the observed ACT value: low level (ACT < 170 s, Group A), intended target level (ACT 170-210 s Group B) and high level (ACT > 210 s, Group C). The relationship of aPTT in each group was analyzed. RESULTS: The mean ACT and aPTT values were 189.39 ± 48.27 s (IQR, 163-202) and 71.85 ± 45.32 s (IQR, 44.5-81.8), respectively. Although the observed mean ACT value of 189.39 s was similar to the intended mean target value of 190 s (p = 0.823), the observed mean aPTT value (71.85 s) was significantly lower than the predicted mean target value (77.5 s, p = 0.027). Despite the mean ACT values being significantly different in each group (p < 0.0001), the mean aPTT values were not statistically different between Groups A and B (p = 0.317). Of the Group B samples (n = 139), only 31 samples (22.3%) met the optimal therapeutic aPTT range. Pearson's correlation coefficient for Group B showed only a weak correlation between ACT and aPTT (r = 0.177; p = 0.037). CONCLUSIONS: Our study demonstrates that the ACT test alone does not seem to be enough to optimize therapeutic heparin dosage adjustment during e-CPR.
Assuntos
Reanimação Cardiopulmonar , Oxigenação por Membrana Extracorpórea , Heparina/administração & dosagem , Heparina/farmacocinética , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Tempo de Coagulação do Sangue TotalRESUMO
Ever since Hattori et al. had described the mediastinal Mullerian cyst in 2005 there has been several new cases described in the literature. We report a 51-year-old woman with an incidentally found 2 cm × 3 cm mass in her left paravertebral mediastinum. She underwent thoracoscopic removal with the impression of a neurogenic tumor and was unexpectedly found with a ciliated cyst of Mullerian origin.
Assuntos
Histiocitose de Células de Langerhans/cirurgia , Osteotomia/métodos , Periósteo/cirurgia , Costelas/cirurgia , Cirurgia Torácica Vídeoassistida , Adolescente , Feminino , Histiocitose de Células de Langerhans/diagnóstico por imagem , Humanos , Periósteo/diagnóstico por imagem , Radiografia , Costelas/diagnóstico por imagem , Resultado do TratamentoRESUMO
Nonossifying fibromas are not uncommon, but those described in the rib are unique. We report the case of a 15-year-old patient with symptoms of chest wall pain for 5 days who underwent a video-assisted thoracoscopic rib resection for a 2.5-cm rib mass. Unexpectedly, pathological results revealed a nonossifying fibroma of the rib. The results showed excellent cosmesis and new bone formation because of the preservation of the overlying periosteum.
RESUMO
We report a case of a postinfarction ventricular septal defect caused by an acute recurrent occlusion after the implantation of a covered stent, which was performed as a rescue procedure for the ruptured left anterior descending artery during a percutaneous coronary intervention. Although the emergent implantation of a covered stent for the ruptured coronary arteries such as the left main coronary artery or the origins of the left anterior descending artery can be performed during a percutaneous coronary intervention, and a coronary bypass surgery should be considered in order to decrease the risk of complete occlusion, thus providing a superior long term patency.
RESUMO
Pectus excavatum is rare, but it is the most common type of sternal congenital disorder. There are many surgical methods to correct pectus excavatum such as the Ravitch method, Wada method, Silastic mold method, and the Nuss operation. We report a case of minimal invasive surgery for pectus excavatum using a polyvinyl alcohol sponge.
RESUMO
The Nuss procedure for pectus excavatum is a well-known technique. Although there are numerous reports on the Nuss procedure, the reports on its removal are few. Removal has been done with many variations in the supine position, which involves bending the bar or bringing the bar beneath the operating table, which can prove to be troublesome and dangerous. Our simple technique allows easy removal of the substernal bar without bar bending. This technique was used in 21 patients without complication.
Assuntos
Remoção de Dispositivo/métodos , Tórax em Funil/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Decúbito Ventral , Próteses e ImplantesRESUMO
Adenoid cystic carcinoma (ACC) arising from anatomic sites other than the salivary gland is rare and those occurring in the lung are extremely rare. When arising from the lung, the tumor generally arises from extrapulmonary bronchi, originating from bronchial glands. Primary ACC of the lung located peripherally within lung parenchyma is an even rarer event. To the best of our knowledge, this is the first case of primary peripheral pulmonary ACC preoperatively diagnosed by fine needle aspiration cytology (FNAC). We report a case of primary peripheral ACC of the anterior segment of the right upper lobe in a 46-year-old woman diagnosed by FNAC and a brief review of the literature.
Assuntos
Carcinoma Adenoide Cístico/diagnóstico , Neoplasias Pulmonares/diagnóstico , Biópsia por Agulha Fina , Carcinoma Adenoide Cístico/patologia , Carcinoma Adenoide Cístico/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Achados Incidentais , Doenças da Laringe/diagnóstico , Doenças da Laringe/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Cirurgia Assistida por ComputadorRESUMO
Finding 2 primary benign lesions at 2 extremes of the mediastinum is a rare event. A minimal invasive operation performed in a single-staged procedure can prove to be difficult, especially when the procedure is performed with a robot. We discuss the positioning and details of the procedure carried out in a 52-year-old woman with acute pancreatitis.
Assuntos
Cisto Mediastínico/cirurgia , Neoplasias do Mediastino/cirurgia , Neurilemoma/cirurgia , Pancreatite/complicações , Robótica , Toracoscopia , Timectomia/métodos , Doença Aguda , Feminino , Humanos , Cisto Mediastínico/complicações , Cisto Mediastínico/diagnóstico , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Neurilemoma/complicaçõesAssuntos
Displasia Fibrosa Poliostótica/cirurgia , Osteotomia/métodos , Costelas/cirurgia , Cirurgia Torácica Vídeoassistida , Adolescente , Displasia Fibrosa Poliostótica/diagnóstico por imagem , Humanos , Masculino , Periósteo/cirurgia , Costelas/anormalidades , Costelas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Xanthomas of the rib are extremely rare benign neoplasms, most commonly reported in soft tissue, but rarely in bone. We report a case of a 4-cm xanthoma of the rib resected by video-assisted thoracoscopic surgery and pulled through a 2-cm port incision around the patient's areola. To the best of our knowledge, there are only 8 other such cases, and none of which were removed by thoracoscopic surgery.
Assuntos
Neoplasias Ósseas/cirurgia , Costelas/cirurgia , Cirurgia Torácica Vídeoassistida , Xantomatose/cirurgia , Adulto , Neoplasias Ósseas/patologia , Dor no Peito , Humanos , Masculino , Costelas/patologia , Xantomatose/patologiaAssuntos
Derrame Pleural/diagnóstico , Teratoma/complicações , Neoplasias do Timo/complicações , Adolescente , Humanos , Masculino , Derrame Pleural/diagnóstico por imagem , Radiografia , Ruptura Espontânea/complicações , Ruptura Espontânea/etiologia , Teratoma/diagnóstico por imagem , Teratoma/patologia , Teratoma/cirurgia , Timectomia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgiaRESUMO
BACKGROUND: Traumatic pulmonary pseudocysts or post-traumatic pneumatocoeles are a relatively rare-encountered condition occurring after trauma and an even rarer talked about subject. Most resolve within a few weeks, but if complicated by hematoma, may persist for months. This study intends to evaluate the resolution times of traumatic pulmonary pseudocysts and their clinical significance. METHODS: We report a case analysis of 12 cases from Hanyang University Guri Hospital dating from July 1997 through October 2004. RESULTS: The overall mean time for complete resolution was 85.6 days. The mean time for resolution for the uncomplicated traumatic pulmonary pseudocysts was 25.3 days (n=6) and the mean time for resolution for the complicated (blood filled) traumatic pulmonary pseudocysts was 145.8 days (n=6). When resolution times were compared according to size, those less than 2 cm showed a mean resolution time of 23.6 days (n=5) and those greater than or equal to 2 cm showed a mean resolution time of 129.9 days (n=7). CONCLUSIONS: Comparisons between completely blood-filled pseudocysts and uncomplicated pseudocysts have shown statistically significant differences in resolution times. Statistical significance has also been found between pseudocysts of sizes less than 2 cm and those greater than or equal to 2 cm. Conservative treatment is generally the rule; close follow-up and symptomatic treatment are necessary.
Assuntos
Cistos/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Adulto , Dor no Peito/etiologia , Criança , Pré-Escolar , Cistos/etiologia , Dispneia/etiologia , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Pneumopatias/etiologia , Masculino , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Traumatismos Torácicos/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Thoracic sympathicotomy for the treatment of axillary hyperhidrosis with the use of 2 mm thoracoscope and instruments is a simple and safe procedure. Nerve paralysis of any type after thoracic sympathicotomy is an extremely rare event. We report a 44-year-old woman who developed brachial plexus injury of her left arm after thoracoscopic sympathicotomy for axillary hyperhidrosis. The lesion involved the whole arm. All nerves of the brachial plexus except the axillary nerve recovered quickly. An axillary nerve type lesion was observed for 7 weeks, until the patient fully recovered all functions of her arm. The mechanism is believed not to be caused by the procedure itself, but by dorsal overextension of the abducted arm during the operation.