Cardiac tamponade in an infant during contrast infusion through central venous catheter for chest computed tomography / Tamponamento cardíaco durante infusão de contraste em acesso venoso central para realização de tomografia computadorizada de tórax em lactente

Complications from central venous catheterization include infectious conditions, pneumothorax, hemothorax and venous thrombosis. Pericardial effusion with cardiac tamponade hardly occurs, and in infants is generally caused by umbilical catheterization. The authors describe the case of cardiac tamponade occurred in an infant during chest computed tomography with contrast infusion through a central venous catheter inserted into the right internal jugular vein.

Analysis and validation of probabilistic models for predicting malignancy in solitary pulmonary nodules in a population in Brazil.

OBJECTIVE: To analyze clinical and radiographic findings that influence the pathological diagnosis of solitary pulmonary nodule (SPN) and to compare/validate two probabilistic models for predicting SPN malignancy in patients with SPN in Brazil. METHODS: This was a retrospective study involving 110 patients diagnosed with SPN and submitted to resection of SPN at a tertiary hospital between 2000 and 2009. The clinical characteristics studied were gender, age, presence of systemic comorbidities, history of malignancy prior to the diagnosis of SPN, histopathological diagnosis of SPN, smoking status, smoking history, and time since smoking cessation. The radiological characteristics studied, in relation to the SPN, were presence of spiculated margins, maximum transverse diameter, and anatomical location. Two mathematical models, created in 1997 and 2007, respectively, were used in order to determine the probability of SPN malignancy. RESULTS: We found that SPN malignancy was significantly associated with age (p = 0.006; OR = 5.70 for age > 70 years), spiculated margins (p = 0.001), and maximum diameter of SPN (p = 0.001; OR = 2.62 for diameters > 20 mm). The probabilistic model created in 1997 proved to be superior to that created in 2007-area under the ROC curve (AUC), 0.79 ± 0.44 (95% CI: 0.70-0.88) vs. 0.69 ± 0.50 (95% CI: 0.59-0.79). CONCLUSIONS: Advanced age, greater maximum SPN diameter, and spiculated margins were significantly associated with the diagnosis of SPN malignancy. Our analysis shows that, although both mathematical models were effective in determining SPN malignancy in our population, the 1997 model was superior.

Análise e validação de modelos probabilísticos de malignidade de nódulo pulmonar solitário em uma população no Brasil / Analysis and validation of probabilistic models for predicting malignancy in solitary pulmonary nodules in a population in Brazil

OBJETIVO: Analisar características clínicas e radiográficas que influenciaram o diagnóstico anatomopatológico de nódulo pulmonar solitário (NPS) e comparar/validar dois modelos probabilísticos de malignidade do NPS em pacientes com NPS no Brasil. MÉTODOS: Análise retrospectiva de 110 pacientes com diagnóstico de NPS submetidos à ressecção em um hospital terciário no período entre 2000 e 2009. As características clínicas estudadas foram gênero, idade, presença de comorbidades sistêmicas, história de neoplasia maligna ao diagnóstico de NPS, diagnóstico histopatológico do NPS, tabagismo, carga tabágica e tempo de cessação do tabagismo. As características radiográficas avaliadas em relação ao NPS foram presença de margens espiculadas, tamanho do maior diâmetro transversal e localização anatômica do NPS. Foram utilizados dois modelos matemáticos, criados em 1997 e 2007, respectivamente, para determinar a probabilidade de malignidade do NPS. RESULTADOS: Houve associações significantes entre malignidade do NPS e idade (p = 0,006; OR = 5,70 para idade >70 anos), presença de margens espiculadas (p = 0,001) e diâmetro maior do NPS (p = 0,001; OR = 2,62 para diâmetro >20 mm). O modelo probabilístico de 1997 mostrou-se superior ao de 2007 - área sob a curva [ASC] ROC = 0,79 ± 0,44 (IC95%: 0,70-0,88) vs. ASC = 0,69 ± 0,50 (IC95%: 0,59-0,79). CONCLUSÕES: Idade elevada, maior diâmetro do NPS e presença de margens espiculadas tiveram associações significantes ao diagnóstico de malignidade do NPS. Nossa análise mostrou que, embora os dois modelos matemáticos sejam eficazes na determinação de malignidade do NPS nessa população, o modelo de 1997 mostrou-se superior.

OBJECTIVE: To analyze clinical and radiographic findings that influence the pathological diagnosis of solitary pulmonary nodule (SPN) and to compare/validate two probabilistic models for predicting SPN malignancy in patients with SPN in Brazil. METHODS: This was a retrospective study involving 110 patients diagnosed with SPN and submitted to resection of SPN at a tertiary hospital between 2000 and 2009. The clinical characteristics studied were gender, age, presence of systemic comorbidities, history of malignancy prior to the diagnosis of SPN, histopathological diagnosis of SPN, smoking status, smoking history, and time since smoking cessation. The radiological characteristics studied, in relation to the SPN, were presence of spiculated margins, maximum transverse diameter, and anatomical location. Two mathematical models, created in 1997 and 2007, respectively, were used in order to determine the probability of SPN malignancy. RESULTS: We found that SPN malignancy was significantly associated with age (p = 0.006; OR = 5.70 for age > 70 years), spiculated margins (p = 0.001), and maximum diameter of SPN (p = 0.001; OR = 2.62 for diameters > 20 mm). The probabilistic model created in 1997 proved to be superior to that created in 2007-area under the ROC curve (AUC), 0.79 ± 0.44 (95% CI: 0.70-0.88) vs. 0.69 ± 0.50 (95% CI: 0.59-0.79). CONCLUSIONS: Advanced age, greater maximum SPN diameter, and spiculated margins were significantly associated with the diagnosis of SPN malignancy. Our analysis shows that, although both mathematical models were effective in determining SPN malignancy in our population, the 1997 model was superior.

Migration of a Kirschner wire into the thoracic ascendent aorta artery.

The orthopedic metallic pins and wires migration for the chest cavity is uncommon and rarely reported in medical literature although it is potentially lethal, especially when they reach the heart or mediastinum great vessels. We reported a case of Kirschner wire withdrawal, for right postero-lateral thoracotomy, which were transfixating ascendent thoracic aorta artery, in its due to its migration of left clavicle, where it was placed to fix an occurred fracture 10 years before.

Migração de fio de Kirschner transfixando artéria aorta torácica ascendente / Migration of a Kirschner wire into the thoracic ascendent aorta artery

A migração de pinos e hastes metálicas ortopédicos para a cavidade torácica é rara e pouco descrita na literatura médica, embora seja potencialmente fatal, principalmente quando atingem o coração ou grandes vasos intratorácicos. Reportamos um caso de migração de fio de Kirschner, implantado na clavícula direita há 10 anos, transfixando a aorta torácica em sua porção ascendente, sendo retirado por toracotomia póstero-lateral esquerda.

The orthopedic metallic pins and wires migration for the chest cavity is uncommon and rarely reported in medical literature although it is potentially lethal, especially when they reach the heart or mediastinum great vessels. We reported a case of Kirschner wire withdrawal, for right postero-lateral thoracotomy, which were transfixanting ascendent thoracic aorta artery, in its due to its migration of left clavicle, where it was placed to fix an occurred fracture 10 years before.

Mediastinite descendente necrosante: tratamento cirúrgico torácico minimamente invasivo / Descending necrotizing mediastinitis: minimally invasive thoracic surgical treatment

OBJETIVO: Relatar uma série de casos de pacientes com mediastinite descendente necrosante (MDN) tratados com cirurgia torácica minimamente invasiva. MÉTODOS: Relatamos os casos de três pacientes com MDN submetidos à desbridamento mediastinal através de cirurgia torácica videoassistida no Hospital São Paulo, São Paulo (SP), desde a sua admissão até o desfecho final. RESULTADOS: Os três pacientes apresentaram boa evolução pós-operatória, com tempo médio de internação de 16,7 dias. CONCLUSÕES: Concluímos que a videotoracoscopia é uma técnica efetiva para a drenagem mediastinal no tratamento da MDN, com os benefícios da cirurgia minimamente invasiva: menos dor pós-operatória, menor liberação de fatores inflamatórios, retorno precoce às atividades diárias e melhores resultados estéticos.

OBJECTIVE: To report a case series of patients with descending necrotizing mediastinitis (DNM) who were treated with minimally invasive thoracic surgery. METHODS: We report three cases of male patients with DNM who underwent mediastinal debridement by video-assisted thoracic surgery at the Hospital São Paulo, located in the city of São Paulo, Brazil, from admission to the final outcome. RESULTS: The postoperative evolution was favorable in all three cases. The mean length of hospital stay was 16.7 days. CONCLUSIONS: We conclude that video-assisted thoracoscopy is an effective technique for mediastinal drainage in the treatment of DNM, with the benefits common to minimally invasive surgery: less postoperative pain, lower production of inflammatory factors, earlier return to activities of daily living, and better aesthetic results.

Descending necrotizing mediastinitis: minimally invasive thoracic surgical treatment.

OBJECTIVE: To report a case series of patients with descending necrotizing mediastinitis (DNM) who were treated with minimally invasive thoracic surgery. METHODS: We report three cases of male patients with DNM who underwent mediastinal debridement by video-assisted thoracic surgery at the Hospital São Paulo, located in the city of São Paulo, Brazil, from admission to the final outcome. RESULTS: The postoperative evolution was favorable in all three cases. The mean length of hospital stay was 16.7 days. CONCLUSIONS: We conclude that video-assisted thoracoscopy is an effective technique for mediastinal drainage in the treatment of DNM, with the benefits common to minimally invasive surgery: less postoperative pain, lower production of inflammatory factors, earlier return to activities of daily living, and better aesthetic results.