RESUMO
OBJECTIVE: Esophageal perforation (EP) is a critical and potentially life-threatening condition with considerable rates of morbidity and mortality. Despite many advances in thoracic surgery, the management of patients with EP is still controversial. MATERIALS AND METHODS: We retrospectively reviewed 34 patients treated for EP, 62% male, mean age 53.9 years. Sixty-two percent of the EPs were iatrogenic. Spontaneous and traumatic EP rates were 26% and 6%, respectively. Three patients had EP in the cervical esophagus and 31 in the thoracic esophagus. RESULTS: Mean time to initial treatment was 34.2 hours. Twenty patients comprised the early group <24 h) and 14 patients the late group (>24 h). Management of the EP included primary closure in 30 patients, non-surgical treatment in two, stent in one and resection in one. Mortality occurred in nine of the 34 patients (26%). Mortality was EP-related in four patients. Three of the nine patients that died were in the early group (p<0.05). Mean hospital stay was 13.4 days. CONCLUSION: EP remains a potentially fatal condition and requires early diagnosis and accurate treatment to prevent the morbidity and mortality.
Assuntos
Histiocitose Sinusal/diagnóstico , Doenças do Mediastino/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Feminino , Histiócitos/química , Histiócitos/patologia , Histiocitose Sinusal/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico , Linfonodos/patologia , Doenças do Mediastino/diagnóstico por imagem , Exame Físico , Proteínas S100/análise , Timoma/diagnóstico , Neoplasias do Timo/diagnóstico , Tomografia Computadorizada por Raios XAssuntos
Acetilcisteína/efeitos adversos , Antivirais/efeitos adversos , Erros de Medicação/efeitos adversos , Aspiração Respiratória/induzido quimicamente , Síndrome do Desconforto Respiratório/induzido quimicamente , Acetilcisteína/administração & dosagem , Administração Oral , Idoso , Antivirais/administração & dosagem , Causalidade , Edema/induzido quimicamente , Tratamento de Emergência/métodos , Glote , Humanos , Masculino , Aspiração Respiratória/diagnóstico , Aspiração Respiratória/terapia , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/terapia , Solubilidade , ComprimidosRESUMO
Primary tumors of the tracheobronchial tree are rare, and benign tumors are even rarer. Patients with tracheobronchial tumors are at times wrongly diagnosed with asthma. A 77-year-old woman presented to our Emergency Department with increasing dyspnea and stridor. She had been treated for bronchial asthma for the last 7 years. Due to the presence of the stridor, a cervical soft tissue computed tomography scan was performed. It revealed a tracheal polyp at the level of the thyroidal isthmus. Polyp excision with rigid bronchoscopy was performed by a thoracic surgeon. This case demonstrates that intratracheal masses should be considered in patients with dyspnea and stridor or in patients with asthma refractory to usual treatment.
Assuntos
Asma/diagnóstico , Neurilemoma/diagnóstico , Pólipos/diagnóstico , Doenças da Traqueia/diagnóstico , Neoplasias da Traqueia/diagnóstico , Idoso , Dispneia/etiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Imuno-Histoquímica , Neurilemoma/complicações , Sons Respiratórios/etiologia , Proteínas S100/metabolismo , Doenças da Traqueia/complicações , Neoplasias da Traqueia/complicações , Vimentina/metabolismoAssuntos
Hematoma/patologia , Baço/lesões , Ferimentos não Penetrantes , Adulto , Humanos , MasculinoRESUMO
OBJECTIVE: Sleeve resection with or without lung resection is a valid conservative operation for patients with benign or malignant tumors; it enables the preservation of lung parenchyma. The aim of this prospective randomized study was to compare complications, operating time, and bronchial healing between the techniques of interrupted and continuous suturing for bronchial anastomosis in dogs. METHODS: Twenty adult mongrel dogs each weighing 18-22 kg (average: 20 kg) were divided into two groups according to the anastomosis technique performed: group A, interrupted suturing and group B, continuous suturing. Each group comprised of 10 dogs. Following right thoracotomy, sleeve resection of the right cranial lobe was performed in all dogs. Basic interrupted sutures using 4/0 Vicryl (Ethicon, USA) were used in group A, and continuous sutures were used in group B. RESULTS: The median anastomosis time was 15.2 min (range: 13-21 min) in group A and 9.6 min (range: 8-13 min) in group B. In all dogs, the anastomosis line was resected via right pneumonectomy for histopathological investigation 1 month after sleeve resection. Histopathological examination revealed that the healing of the anastomosis was not affected by the suturing technique applied. One dog from each group died on the fourth postoperative day; Fisher's exact test, p=0.763. CONCLUSIONS: Our research revealed that the healing of the anastomosis was not affected by the suturing technique performed.
Assuntos
Brônquios/cirurgia , Neoplasias Pulmonares/cirurgia , Técnicas de Sutura , Anastomose Cirúrgica/métodos , Animais , Brônquios/patologia , Cães , Pneumonectomia/métodos , CicatrizaçãoRESUMO
OBJECTIVE: Lung injury induced by one-lung ventilation is rare, but it is a condition that may result in high mortality. This study evaluates the effects of one-lung ventilation and occlusion time on collapsed and contralateral lungs. METHODS: Sprague-Dawley rats were allocated randomly into 7 groups consisting of 6 animals each: sham; O1, 1 hour of occlusion/2 hours of re-expansion; C1, 3 hours of mechanical ventilation control; O2, 2 hours of occlusion/2 hours of re-expansion; C2, 4 hours of mechanical ventilation control; O3, 3 hours of occlusion/2 hours of re-expansion; and C3, 5 hours of mechanical ventilation control groups. In the occlusion groups, the left lung was collapsed by bronchial occlusion. Malondialdehyde activity was determined in the blood, and myeloperoxidase and malondialdehyde activity was determined in the collapsed and contralateral lungs. Lung tissues were also examined histopathologically. RESULTS: Malondialdehyde and myeloperoxidase levels rose as occlusion duration increased. This increase was greater in the occlusion groups than that in their own control groups. Increases were significant in the O2 compared with the O1 groups (P < .005). Histologically, tissue damage increased as occlusion time rose injury in collapsed and contralateral lungs. Injury was greater in the occlusion groups than injury in their own control groups (P < .005). CONCLUSIONS: Our findings show that biochemical and histopathologic injury occur in collapsed and contralateral lungs in one-lung ventilation, and this injury increases as occlusion time rises. We believe that occlusion and occlusion time-related injury should be borne in mind in the clinic under conditions requiring the application of one-lung ventilation.