Etiology of primary spontaneous pneumothorax.

With the advent of HRCT, primary spontaneous pneumothorax has come to be better understood and managed, because its etiology can now be identified in most cases. Primary spontaneous pneumothorax is mainly caused by the rupture of a small subpleural emphysematous vesicle (designated a bleb) or of a subpleural paraseptal emphysematous lesion (designated a bulla). The aim of this pictorial essay was to improve the understanding of primary spontaneous pneumothorax and to propose a description of the major anatomical lesions found during surgery. RESUMO Com o advento da TCAR, o pneumotórax espontâneo primário passou a ser mais bem entendido e conduzido, pois sua etiologia pode ser atualmente identificada na maioria dos casos. O pneumotórax espontâneo primário tem como principal causa a rotura de uma pequena vesícula enfisematosa subpleural, denominada bleb ou de uma lesão enfisematosa parasseptal subpleural, denominada bulla. O objetivo deste ensaio pictórico foi melhorar o entendimento do pneumotórax espontâneo primário e propor uma descrição das principais lesões anatômicas encontradas durante a cirurgia.

Etiology of primary spontaneous pneumothorax / A etiologia do pneumotórax espontâneo primário

ABSTRACT With the advent of HRCT, primary spontaneous pneumothorax has come to be better understood and managed, because its etiology can now be identified in most cases. Primary spontaneous pneumothorax is mainly caused by the rupture of a small subpleural emphysematous vesicle (designated a bleb) or of a subpleural paraseptal emphysematous lesion (designated a bulla). The aim of this pictorial essay was to improve the understanding of primary spontaneous pneumothorax and to propose a description of the major anatomical lesions found during surgery.

RESUMO Com o advento da TCAR, o pneumotórax espontâneo primário passou a ser mais bem entendido e conduzido, pois sua etiologia pode ser atualmente identificada na maioria dos casos. O pneumotórax espontâneo primário tem como principal causa a rotura de uma pequena vesícula enfisematosa subpleural, denominada bleb ou de uma lesão enfisematosa parasseptal subpleural, denominada bulla. O objetivo deste ensaio pictórico foi melhorar o entendimento do pneumotórax espontâneo primário e propor uma descrição das principais lesões anatômicas encontradas durante a cirurgia.

Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis.

With the objective of establishing guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis, consensus meetings were held. Attendees included a general surgeon and thoracic surgeons affiliated with the Brazilian Society of Thoracic Surgery. The topics addressed were those that would ostensibly broaden multidisciplinary knowledge. Based on recent guidelines for the prevention, diagnosis and (clinical and surgical) treatment of compensatory hyperhidrosis, as well as on a review of the medical literature, the participants prepared a preliminary text, whose recommendations were revised and subsequently approved by all of the participants. The consensus text was posted on the Internet, becoming the object of further corrections and revisions prior to taking on its present form.

Diretrizes para a prevenção, diagnóstico e tratamento da hiperidrose compensatória / Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis

Com o objetivo de se estabelecer diretrizes para a prevenção, o diagnóstico e o tratamento da hiperidrose compensatória, foram realizadas reuniões consensuais com a participação de cirurgiões torácicos filiados à Sociedade Brasileira de Cirurgia Torácica e um cirurgião geral em que foram abordados tópicos de modo a abranger conhecimentos multidisciplinares. A partir de textos recentes com diretrizes para a prevenção, o diagnóstico e tratamento (clínico e cirúrgico) da hiperidrose compensatória, e baseados em revisão bibliográfica, os participantes elaboraram um texto preliminar, cujas recomendações foram submetidas à aprovação dos participantes, possibilitando uma revisão geral do texto final. Deste modo, obteve-se um texto básico que, veiculado pela internet, tornou-se objeto de novas correções e revisões até alcançar a forma final atual.

With the objective of establishing guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis, consensus meetings were held. Attendees included a general surgeon and thoracic surgeons affiliated with the Brazilian Society of Thoracic Surgery. The topics addressed were those that would ostensibly broaden multidisciplinary knowledge. Based on recent guidelines for the prevention, diagnosis and (clinical and surgical) treatment of compensatory hyperhidrosis, as well as on a review of the medical literature, the participants prepared a preliminary text, whose recommendations were revised and subsequently approved by all of the participants. The consensus text was posted on the Internet, becoming the object of further corrections and revisions prior to taking on its present form.

Spontaneous rupture of the esophagus: report of two cases

Objetive - To study the diagnosis, prognosis and management of spontaneous rupture of the esophagus. Design: This is a retrospective study through the analysis of two cases with delayed diagnosis and subsequent treatment at the Track Surgery Service. Locale: The study was performed at the Thoracic Surgery Unit of the Hospital do Servidor Público Estadual Francisco Morato de Oliveira in the city of Sao Paulo. This is a specialized service. Participants: The two patients reported on had suffered spontaneous rupture of the esophagus. They were transferred to the Thoracic Surgery Unit because of the worsening of their condition in the previous institution which they had been admitted into. Measurement: The two patients with esophagus pleural fistula received similar treatment, initially advocated by Kanashin in Russia and Hauer-Santos in the United States, which consists of washing the fistula and using continous pleural aspiration. Results: Although both patients had to spend a long period of time in hospital, their evolution was satisfactory with the treatment adopted, and the fistulla closed. Conclusion: The authors conclude that the method of lavage of the mediastinum and continuous pleural aspiration, in patients who after spontaneous rupture of the esophagus developed a pleural esophagus fistula due to belated diagnosis, is an alternative and satisfactory therapy. Furthermore, in order to have the best outcome, an early diagnosis is recommended and thoracostomy as the surgical procedure, with primary suture.

Toracocospia: tratamento do pneumotórax espontâneo com ligadura elástica / Thoracoscopy: spontaneous pneumothorax treatment with rubber bandage

Uma nova técnica toracoscópica foi realizada, com sucesso, em 4 pacientes para o tratamento do pneumotórax espontâneo. O instrumental cirúrgico utilizado foi o mesmo do tratamento de hemorróidas por ligadura elásticas, que foi introduzido na cavidade pleural através de anuscópio, o qual foi utilizado como um toracoscópio. As bolhas pulmonares foram englobadas por ligaduras de borracha elática de silicone, obtendo-se o fechamento da fístula aérea

Mediastinitis after cervical suppuration

The objective of this study is to decode the etiopathogenesis, the clinical feature, the diagnosis and the prognosis of the acute mediastinitis resulting of infectious processes of the cephalic segment. Three out of five patients studied presented focus of dental origin and two patients presented focus in the face area. One of them presented Ludwig's Angina before the suppurative process would spread over the mediastinum. In the others, there was fast expansion through the fascial spaces of the neck and, in two of them, besides the mediastinum, there was pleuropericardial involvement. Three patients died due to respiratory insufficiency and two survived with complications. The mediastinitis after cervical suppuration is a special and extremely serious kind of endothoracic infection. The pus reaches that area through the fascial spaces of the neck, taking the organism to an alarming toxemic feature. The rarity of the disease, the little is known about its physiopathology and the initial care of the patient in non-specialized services, which are not familiarized with this type of feature, are factors that can delay the diagnosis and worsen the prognosis

Microcirurgia em mediastinoscopia / Microsurgery at mediatinoscopy

Em certos casos de neoplasias que infiltram o mediastino ou após radioterapia, torna-se difícil a biópsia mediastinal com as pinças convencionais para mediastinoscopia. O uso de instrumental cirúrgico para microcirurgia (tesouras e pinças) facilita a dissecçäo e biópsia do mediastino. Foram estudados 59 pacientes. Grupo I: estadiamento do carcinoma do pulmäo (25 pacientes) - 16 sem comprometimento metastático ganglionar (um falso-negativo), nove com comprometimento ganglionar. Grupo II: diagnóstico e concomitante estadiamento do carcinoma do pulmäo (15 pacientes) - três carcinomas epidermóides, oito adenocarcinomas, um carcinoma indiferenciado de pequenas células, três carcinomas indiferenciados de grandes células. Grupo III: diagnóstico de adenopatias mediastinais (13 pacientes) - quatro sarcoidoses, três tuberculoses, dois linfomas, um carcinoma metastático, três sarcoidoses, três tuberculoses, dois linfomas, um carcinoma metastático, três hiperplasias ganglionares. Grupo IV: diagnóstico de massas tumorais (seis pacientes) - quatro linfomas, um tireóide, um aneurisma dissecante. Grupo I + II: sensibilidade 96%, especificidade 100%, eficiência 97%. Grupo III + IV: sensibilidade 100%, especificidade 100%, eficiência 100%. Complicaçöes: uma fistula broncopleural, uma paralisia transitória de corda vocal. O instrumental acrescenta, à técnica de mediastinoscopia, a possibilidade de microdissecçöes e, também, pode ser empregado para coibir sangramentos, utilizando-se micropinças hemostáticas e pinças porta-grampo

Mediastinite conseqüente a infecçäo dentária: relato de dois casos / Mediastinitis following dental infection: report of 2 cases

Relatam-se dois casos de mediastinite conseqüentes de infecçöes dentárias ocorridas no Serviço de Cirurgia Torácica do Hospital do Servidor Público Estadual "Francisco Morato de Oliveira". Comentam-se as vias de propagaçäo do processo supurativo pelas fáscias do pescoço, tratamento instituído e evoluçäo. Fazem-se comparaçäo com outros casos publicados na literatura mundial, onde puderam também constatar a alta morbidade e mortalidade da doença, apesar do melhor tratamento administrado. Alerta-se para a necessidade do diagnóstico precoce, que tem grande importância sobre o prognóstico