Assuntos
Doenças do Pé/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagem , Sarcoma Sinovial/diagnóstico , Neoplasias de Tecidos Moles/diagnóstico , Adulto , Biópsia , Dor no Peito/etiologia , Doenças do Pé/patologia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/secundário , Masculino , Sarcoma Sinovial/complicações , Sarcoma Sinovial/secundário , Neoplasias de Tecidos Moles/patologiaRESUMO
Primary lymphoma presenting as a solitary lesion of the chest wall is extremely rare, as the majority of chest-wall tumours arise from metastasis. We demonstrate a case report of a 67-year-old male who underwent investigations for a chronic left-sided pleural effusion. A computed tomography scan demonstrated a large chest-wall lesion, without rib destruction. He subsequently underwent fine needle aspirations and excisional biopsy for a histological diagnosis.
RESUMO
Up to 150 words summarising the case presentation and outcome (this will be freely available online). A Marfan case with dilated aortic root and prolapsed leaflets underwent aortic repair. The non-coronary leaflet-measured effective height was 7 mm (prolapsing) and was lifted up to 10 mm with a centrally placed plicating sutures. The right coronary leaflet had a geometric height of 17 mm (restricted) and was enlarged up to 21 mm with an autologous pericardial patch. The enlarged root was repaired with an inclusion technique. The final result showed a competent valve. This report outlines the feasibility of aortic repair provided one adheres to the principles of aortic valve repair.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Procedimentos Cirúrgicos Cardíacos , Síndrome de Marfan/complicações , Adulto , Aneurisma da Aorta Torácica/diagnóstico por imagem , Ecocardiografia , Humanos , Masculino , Esternotomia , Tomografia Computadorizada por Raios XRESUMO
Chronically ruptured diaphragms are difficult to diagnose. Often they are asymptomatic but convey a high risk for incarceration, and therefore surgical repair is mandatory. In the following case report, we present an abnormal 10×12 cm diaphragmatic defect whereby there was no anterior edge to the defect. This posed a challenge as to how to repair. We present a novel technique that facilitates sound solution through a thoracotomy approach.
Assuntos
Hérnia Diafragmática/diagnóstico por imagem , Hérnia Diafragmática/cirurgia , Herniorrafia/métodos , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Sutura , Toracotomia , Tomografia Computadorizada por Raios XAssuntos
Anomalias dos Vasos Coronários/complicações , Aneurisma Cardíaco/etiologia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Diagnóstico Diferencial , Divertículo/diagnóstico por imagem , Aneurisma Cardíaco/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaAssuntos
Endocardite/etiologia , Aneurisma Cardíaco/etiologia , Doenças das Valvas Cardíacas/etiologia , Infarto do Miocárdio/complicações , Infecções Estreptocócicas/complicações , Estreptococos Viridans , Idoso , Valva Aórtica , Endocardite/microbiologia , Endocardite/cirurgia , Aneurisma Cardíaco/cirurgia , Doenças das Valvas Cardíacas/microbiologia , Doenças das Valvas Cardíacas/cirurgia , Ventrículos do Coração , Humanos , MasculinoRESUMO
As previously well described in the literature, the intercostal muscle (ICM) flap can be used to buttress bronchial stumps following lung resection. We describe a harvesting technique of ICM flap which enabled a bi-lobectomy to be avoided in a patient with poor pulmonary function. The Key to this technique is the preservation of the neurovascular bundle. Therefore the flap is not divided anteriorly thereby differentiating it from any previous technique described.We have called it the 'bucket handle' technique, which was used to repair an intra-operative tear in bronchus intermedius. Its efficacy was tested to the full when the patient developed severe adult respiratory distress syndrome (ARDS) secondary to pseudomonas pneumonia and required high-pressure mechanical ventilation. This case demonstrates that ICM flap is an effective buttress to bronchial stumps or repairs and offers reassurance for optimal outcome due to its intact vascular pedicle.
Assuntos
Brônquios/lesões , Brônquios/cirurgia , Músculos Intercostais/transplante , Retalhos Cirúrgicos , Idoso , Broncografia/métodos , Feminino , Humanos , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo/efeitos adversos , Tomografia Computadorizada por Raios XRESUMO
To compare the outcome of sleeve resection or complex sleeve resection versus (Vs) pneumonectomy for lung cancer in a single unit. Between 1998 and 2006, 664 lung resections were carried out. There were 129 (19.4%) pneumonectomies and 79 (11.9%) sleeve resections; Twenty one patients (26.5%) underwent a complex sleeve resection. Operative mortality for the sleeve resections (SR) was 2.5% and for the pneumonectomies 8.53%. Overall 5-year survival after SR was 46.8% and after pneumonectomy 37.1%. The survival curves for the 2 procedures after adjusting for risk factors are different. The area under the curve is higher for the SR (Hazard ratio 1.78 C.I.: 0.92-3.46). The 5-year survival for early stages favors SR. The survival for the complex SR was not influenced by the complexity of the procedure but from the TNM stage of each individual case. Multivariate analysis of risk factors affecting survival after surgery showed: male sex Hazard ratio (HR) 1.19, 0.63-2.27(95%CI), Age >63 1.38(HR), 0.78-2.48, Pneumonectomy 1.78(HR), 0.92-3.46 and stage III 4.44(HR), 1.94-10.16(95% CI). For comparative stages survival appears to be better after sleeves, moreover male sex, sleeve resection, age younger that 63 and early TNM stage are positive predictors for survival.
