RESUMO
BACKGROUND: The number of patients waiting for a lung transplant worldwide greatly exceeds the number of available donors. Ex vivo lung perfusion is a useful tool that allows marginal donor lungs to be evaluated and reconditioned for a successful lung transplantation. AIM: To describe the first Chilean and Latin American experience in ex vivo lung perfusion for marginal donor lungs before transplantation. MATERIAL AND METHODS: Descriptive analysis of all ex vivo lung perfusion conducted for marginal donor lungs at a private clinic, from April 2019 to October 2020. High risk donor lungs and rejected lungs from other transplantation centers were included. The "Toronto Protocol" was used for ex vivo lung perfusion. Donor lung characteristics and recipient outcomes were studied. RESULTS: During the study period, five ex vivo lung perfusions were performed. All lungs were reconditioned and transplanted. No complications were associated. There were no primary graft dysfunctions and only one chronic allograft dysfunction. There was no mortality during the first year. The median arterial oxygen partial pressure/fractional inspired oxygen ratio increased from 266 mm Hg in the donor lung to 419 after 3 hours of ex vivo lung perfusion (p = 0.043). CONCLUSIONS: ex vivo lung perfusion is a safe and useful tool that allows marginal donor lungs to be reconditioned and successfully transplanted.
Assuntos
Transplante de Pulmão , Circulação Extracorpórea , Humanos , América Latina , Pulmão/cirurgia , Perfusão , Doadores de TecidosRESUMO
INTRODUCCIÓN: Para facilitar la localización intraoperatoria de los nódulos pulmonares existe la alternativa de marcarlos previamente con lipiodol. OBJETIVO: Describir los resultados quirúrgicos de los pacientes sometidos a resección por videotoracoscopía de nódulos pulmonares marcados previamente con lipiodol. MATERIAL Y MÉTODOS: Estudio descriptivo. Se incluyeron los pacientes que fueron sometidos a resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol, en Clínica Las Condes e Instituto Nacional del Tórax, entre junio de 2012 y junio de 2019. Se consideraron variables demográficas, radiológicas, quirúrgicas e histológicas. RESULTADOS: Se estudió un total de 93 pacientes. La edad promedio fue 63,5 (± 11,9) años. El tamaño promedio de los nódulos fue de 10,7 (± 5,8) mm. Se identificó y extrajo el 100% de los nódulos marcados. Los días de hospitalización promedio fueron 4,7 (± 6,9). Solo se registró un fallecimiento de causa no quirúrgica. CONCLUSIONES: La resección videotoracoscópica de nódulos pulmonares marcados previamente con lipiodol, es una técnica segura y eficaz.
BACKGROUND: To facilitate the intraoperative location of lung nodules there is the alternative of pre-marking them with lipiodol. OBJECTIVE: To describe the surgical results of patients undergoing videotoracoscopy resection of pulmonary nodules previously marked with lipiodol. MATERIAL AND METHODS: Descriptive study. Patients who underwent videotorcoscopy resection of pulmonary nodules marked with lipiodol were included at Clínica Las Condes and Instituto Nacional del Tórax between June 2012 and June 2019. Demographic, radiological, surgical and histological variables were considered. RESULTS: A total of 93 patients were studied. The average age was 63,5 (± 11.9) years. The average size of the nodules was 10.7 (± 5.8) mm. 100% of the marked nodules were identified and extracted. The average hospitalization days were 4.7 (± 6.9). Only one death of non-surgical cause was recorded. CONCLUSIONS: Videotoracoscopic resection of pulmonary nodules previously marked with lipiodol is a safe and effective technique.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Óleo Etiodado , Cirurgia Torácica Vídeoassistida , Nódulos Pulmonares Múltiplos/cirurgia , Toracoscopia , Estudos Retrospectivos , Resultado do Tratamento , Meios de Contraste , Nódulos Pulmonares Múltiplos/patologia , Nódulos Pulmonares Múltiplos/diagnóstico por imagemRESUMO
INTRODUCCIÓN: en la actualidad no existe un consenso respecto al manejo de los nódulos pulmonares subsólidos (NPSS). OBJETIVO: describir los resultados del manejo quirúrgico de los NPSS, basados en un algoritmo local. MATERIAL Y MÉTODOS: estudio descriptivo de corte transversal. Se revisaron las fichas clínicas electrónicas de los pacientes operados por NPSS, sugerentes de ser malignos, a juicio de un equipo multidisciplinario, entre enero de 2014 y enero de 2018, en el Departamento de Cirugía de Adultos de Clínica Las Condes. RESULTADOS: se estudió un total de 35 pacientes. La edad promedio fue de 65,8 años. El tamaño promedio de los nódulos fue de 15 mm. Todos los pacientes fueron abordados por cirugía videotoracoscópica asistida. El 88,6% de las biopsias demostró la presencia de una neoplasia maligna. CONCLUSIONES: la adopción de un algoritmo local, instituido por un equipo multidisciplinario, es una alternativa para el manejo adecuado de los portadores de NPSS.
BACKGROUND: Nowadays, there is no consensus in the management of pulmonary subsolid nodules (SSNs). AIM: describe the results of surgical management of SSNs, based on institutional algorithm. MATERIAL AND METHODS: cross-sectional, descriptive study, with revision of clinical electronic records, that included all patients intervened for SSNs, suggestive of malignancy, by the judgment of a multi-disciplinary team, from January 2014 to January 2018 at the Department of Adult Surgery, Clinica Las Condes. RESULTS: 35 patients were studied. The average age was 65.8 years. The average size of the nodules was 15 mm. All patients were approached by video-assisted thoracoscopic surgery. 88.6% of biopsies turned out to be malignant neoplasm. CONCLUSIONS: the acquisition of a local algorithm established by a multidisciplinary team is an appropriate alternative for the management of the patients with SSNs.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Nódulos Pulmonares Múltiplos/cirurgia , Algoritmos , Análise de Sobrevida , Estudos Transversais , Seguimentos , Cirurgia Torácica Vídeoassistida , Nódulos Pulmonares Múltiplos/mortalidade , Nódulos Pulmonares Múltiplos/diagnóstico por imagemRESUMO
Background: The number of patients waiting for a lung transplant worldwide greatly exceeds the number of available donors. Ex vivo lung perfusion is a useful tool that allows marginal donor lungs to be evaluated and reconditioned for a successful lung transplantation. Aim: To describe the first Chilean and Latin American experience in ex vivo lung perfusion for marginal donor lungs before transplantation. Material and Methods: Descriptive analysis of all ex vivo lung perfusion conducted for marginal donor lungs at a private clinic, from April 2019 to October 2020. High risk donor lungs and rejected lungs from other transplantation centers were included. The "Toronto Protocol" was used for ex vivo lung perfusion. Donor lung characteristics and recipient outcomes were studied. Results: During the study period, five ex vivo lung perfusions were performed. All lungs were reconditioned and transplanted. No complications were associated. There were no primary graft dysfunctions and only one chronic allograft dysfunction. There was no mortality during the first year. The median arterial oxygen partial pressure/fractional inspired oxygen ratio increased from 266 mm Hg in the donor lung to 419 after 3 hours of ex vivo lung perfusion (p = 0.043). Conclusions: ex vivo lung perfusion is a safe and useful tool that allows marginal donor lungs to be reconditioned and successfully transplanted.
Assuntos
Humanos , Transplante de Pulmão , Perfusão , Doadores de Tecidos , Circulação Extracorpórea , América Latina , Pulmão/cirurgiaRESUMO
Background: Pulmonary nodules are common, and surgery is the only alternative that allows a diagnostic and therapeutic management in a single procedure. Aim: To report the epidemiological, radiological, surgical and pathological features of excised pulmonary nodules. Material and Methods: Review of medical records of patients in whom a pulmonary nodule was excised between 2014 and 2018. Those with incomplete data or without a pathological study were excluded from analysis. Results: We retrieved 108 records and 8 had to be excluded, therefore 100 patients aged 34 to 82 years (57% females) were analyzed. Sixty percent had a history of smoking. Mean nodule size was 16 mm and the solid type was the most common (65%). Forty five percent of nodules had irregular margins and 55% were in the superior lobes. All patients operated by video-assisted thoracoscopic surgery and 40% underwent a lobectomy. Malignant lesions were observed in 87% of biopsies and a pulmonary adenocarcinoma was found in pathology in 40%. Conclusions: A multidisciplinary approach of pulmonary nodules, using adapted international guidelines, accomplishes an appropriate management, decreasing unnecessary surgical interventions.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma/patologia , Nódulos Pulmonares Múltiplos/patologia , Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/patologia , Carcinoma/cirurgia , Carcinoma/epidemiologia , Chile/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Cirurgia Torácica Vídeoassistida/métodos , Carga Tumoral , Nódulos Pulmonares Múltiplos/cirurgia , Nódulos Pulmonares Múltiplos/epidemiologia , Adenocarcinoma de Pulmão/cirurgia , Adenocarcinoma de Pulmão/epidemiologia , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/epidemiologiaRESUMO
BACKGROUND: Pulmonary nodules are common, and surgery is the only alternative that allows a diagnostic and therapeutic management in a single procedure. AIM: To report the epidemiological, radiological, surgical and pathological features of excised pulmonary nodules. MATERIAL AND METHODS: Review of medical records of patients in whom a pulmonary nodule was excised between 2014 and 2018. Those with incomplete data or without a pathological study were excluded from analysis. RESULTS: We retrieved 108 records and 8 had to be excluded, therefore 100 patients aged 34 to 82 years (57% females) were analyzed. Sixty percent had a history of smoking. Mean nodule size was 16 mm and the solid type was the most common (65%). Forty five percent of nodules had irregular margins and 55% were in the superior lobes. All patients operated by video-assisted thoracoscopic surgery and 40% underwent a lobectomy. Malignant lesions were observed in 87% of biopsies and a pulmonary adenocarcinoma was found in pathology in 40%. CONCLUSIONS: A multidisciplinary approach of pulmonary nodules, using adapted international guidelines, accomplishes an appropriate management, decreasing unnecessary surgical interventions.
Assuntos
Adenocarcinoma de Pulmão/patologia , Carcinoma/patologia , Neoplasias Pulmonares/patologia , Nódulos Pulmonares Múltiplos/patologia , Adenocarcinoma de Pulmão/epidemiologia , Adenocarcinoma de Pulmão/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/epidemiologia , Carcinoma/cirurgia , Chile/epidemiologia , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/epidemiologia , Nódulos Pulmonares Múltiplos/cirurgia , Estudos Retrospectivos , Distribuição por Sexo , Cirurgia Torácica Vídeoassistida/métodos , Carga TumoralRESUMO
Introduction: In the past two decades the advances in minimally invasive surgery have revolutionized surgical practices in all subspecialties. In pulmonary resections lobectomy by assisted video-thoracoscopy (VATS) has demonstrated to have less perioperative complications, less inflammatory response and similar oncological results in comparison with lobectomy by thoracotomy. Methods and Patients: We present a retrospective study of 30 patients subjected to lobectomy by VATS. Diagnoses, complications intra and post-surgery, bleeding, conversion to thoracotomy, operatory time, lymphoadenectomy, pleurostomy and hospitalization time, were the variables analyzed. Results: 90 percent of the 30 patients (n = 27) had an oncological diagnosis, the remainder patients had benign lesions (n = 3), all of them presented bronchiectasis. TNM staging showed equal distribution for stages I and II. We obtained on average 13 nodes by lymphoadenoectomy (range: 9 to 18 nodes). Operatory time was 124 min on average. With respect to complications 50 percent of them (n = 3) bleed more than 1,000 mL. The conversion rate in our series was 16.5 percent (n = 5). Pleurostomy lasted 4.09 days on average (range: 2 to 9 days). There was no mortality in our series. Conclusion: In our series, lobectomy by VATS had equal range of intra and post- surgery complications as compared to toracotomy. We believe that our study demonstrates a benefit in the recovery time of our patients.
Introducción: En las últimas dos décadas los avances en cirugía mínimamente invasiva han revolucionado la práctica quirúrgica en todas las subespecialidades. En resecciones pulmonares la lobectomía por videotoracoscopía (VATS), en comparación con resecciones por toracotomía, ha demostrado, además del menor número de complicaciones perioperatorias, una menor respuesta inflamatoria y equivalencia en resultados oncológicos. Pacientes y Métodos: Se presenta una serie retrospectiva de 30 pacientes en quienes se realizó una lobectomía por VATS. Se analizan los resultados con respecto a complicaciones quirúrgicas y postquirúrgicas y considerando variables de diagnóstico, linfadenectomía, sangrado quirúrgico, conversión a toracotomía, tiempo operatorio, días de estadía y días con pleurostomía. Resultados: Las indicaciones quirúrgicas de nuestra serie fueron en un 90 por ciento (n = 27) por patología neoplásica, el 10 por ciento restante (n = 3) correspondió a patología benigna (bronquiectasias). La etapificación TNM dentro del subgrupo de cáncer pulmonar se distribuyó homogéneamente entre las etapas I y II. La linfadenectomía obtuvo un promedio de 13 ganglios con un rango entre 9 y 18. El tiempo quirúrgico promedio fue de 124 minutos. De las complicaciones, un 50 por ciento de estas (n = 3) se debieron a sangrado de más de 1.000 mL. La tasa de conversión en nuestra serie es de 16,6 por ciento (5 casos). El promedio de días con drenaje fue de 4,09 días con rango entre 2 y 9 días. No hubo mortalidad a 60 días. Conclusión: En la serie presentada se evidencia que la lobectomía por VATS es equivalente a la toracotomía con respecto al número de complicaciones. Creemos como equipo que presenta beneficios en el tiempo de recuperación del paciente.
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida , Toracoscopia/métodos , Bronquiectasia/cirurgia , Complicações Intraoperatórias , Tempo de Internação , Excisão de Linfonodo , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Los rescates en lugares remotos y la medicina agreste son áreas que se encuentran en desarrollo desde fines de la década de los sesenta en Estados Unidos. Nuestro país también posee un sistema de rescate en zonas apartadas, el cual se enfrenta a una creciente demanda. Presentamos el ejemplo de una unidad de rescate norteamericana, con el fin de reflexionar acerca de cómo se resuelven estas situaciones en otros países.
Rescue in remote areas and wilderness medicine have been under development in the US since the late 60´s. Chile has also developed a rescue system for remote areas which is currently facing a growing demand. We present the example of an alpine rescue team from the US, so we can reflect upon how other countries face this problems.
Assuntos
Humanos , Resgate em Espaços Confinados , Busca e Resgate , Trabalho de Resgate , Estados UnidosRESUMO
El traumatismo de tórax es una situación altamente desafiante en el manejo de urgencia. Requiere conocimientos de las complicaciones que pueden poner en riesgo vital al paciente en pocos minutos como de un adecuado manejo primario de las complicaciones que se pueden presentar en el mediano y largo plazo. De la mortalidad total del trauma, un 75 por ciento se debe a trauma torácico como causa primaria o como elemento contribuyente. Es por esto que el manejo de estas lesiones torácicas es esencial en el trabajo de urgencia. Un 80 por ciento de las lesiones torácicas pueden manejarse con maniobras no quirúrgicas, pero el 15 por ciento a 20 por ciento restante requerirá manejo quirúrgico, que es altamente desafiante, por lo complejas que pueden llegar a ser las lesiones de estructuras vitales presentes en el tórax. En la siguiente revisión mostramos el manejo de las lesiones más frecuentes en traumatismo torácico y las distintas indicaciones de toracotomías que se pueden presentar en los servicios de urgencia.
Thoracic trauma is an extremely challenging situation in the emergency room. Both ER physicians and surgeons should have knowledge of how to manage immediate life threatening injuries and the related complications that can present later. The primary cause or contributing element of seventy five percent of trauma related mortality is thoracic injury. Eighty percent of thoracic injuries can be managed non-surgically. The remaining 15 percent to 20 per cent will require challenging surgical procedures, due to the involvement of vital organs and vessels. In this review, we present the management of the most common trauma related thoracic injuries that can present in the ER and the different indications for thoracotomy.
Assuntos
Humanos , Fraturas das Costelas/complicações , Lesão Pulmonar/complicações , Toracotomia , Traumatismos Torácicos/terapia , Hemotórax , PneumotóraxRESUMO
Amyloidosis is a generic term for a group of diseases that share the common feature of extracelular deposit of pathologic proteins. Systemic and localized forms are recognized. Both can produce pulmonary involvement. The current classification is based on the nature of the precursor of the amyloid. It is an infrequent condition, in USA the incidence is 5.1 to 12.8 per million of people. We present a case of a 32 years old male, obese, light smoker with Diabetes Mellitus 2, asymptomatic, with a pneumonia and poor response to treatment. The first diagnostic approach was a malignant disease and the histological study showed Amyloidosis. The analysis of the case suggest the diagnosis of tracheobronchial amyloidosis.
La amiloidosis es un término genérico para un conjunto de enfermedades que comparten como hecho común el depósito extracelular de proteínas patológicas. A grandes rasgos se divide en sistémica y localizada. Ambas pueden presentar compromiso pulmonar. Actualmente, su clasificación, se basa en las proteínas precursoras del amiloide. Es una patología poco frecuente, reportándose en USA una incidencia de 5,1 a 12,8 por millón de personas. Presentamos un caso de un enfermo de 32 años de edad obeso con antecedentes de tabaquismo y Diabetes Mellitus 2, asintomático que frente a una neumonía con mala respuesta al tratamiento se plantea una patología maligna y el estudio histológico demuestra amiloidosis. El análisis del caso clínico configura el diagnostico de Amiloidosis localizada endobronquial.
Assuntos
Humanos , Masculino , Adulto , Amiloidose/diagnóstico , Broncopatias/diagnóstico , Doenças da Traqueia/diagnóstico , Broncoscopia , Radiografia Torácica , Vermelho Congo , Tomografia Computadorizada por Raios XRESUMO
Las enfermedades de altura son de causa cerebral y pulmonar. Las primeras se refieren fundamentalmente al mal agudo de montaña y al edema crebral de altura y las segundas al edema pulmonar agudo de montaña. Actuales evidencias señalan que el edema cerebral sería un fenómeno universal de los asciendan alturas y que tres de cuatro individuos sanos que se expongan a altura desarrollarán un edema pulmonar agudo de montaña subclínico. La hipoxia de altura es la responsable de estos cuadros y los sujetos susceptibles serían aquellos que genéticamente tienen una respuesta ventilatoria reducida a la hipoxia y una exagerada respuesta vasopresora pulmonar al ejercicios. Se presenta un caso de edema pulmonar agudo de montaña en un deportista previamente sano que partició en una expedición al cerro El Plomo (5.280 msnm) en la Cordillera de los Andes central. Posteriormente, se comenta la fisiopatología y tratamiento de esta condición.