Acute arterial occlusion of the lower limb as the main clinical manifestation in a patient with Covid-19 - Case Report.

INTRODUTION: COVID-19 infection may predispose to venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilization and disseminated intravascular coagulation; however, there are few reports of lower limb ischemia as the main manifestation of the disease. PRESENTATION OF CASE: Male patient, 69 years old, asthmatic, ex-smoker and bearer of systemic arterial hypertension, has been admitted to the emergency department with sudden onset of pain in the right lower limb (RLL), associated with cyanosis and reduced temperature of the limb. He has been tested for COVID-19 in the OR with positive result for IGG and IGM. Computed tomography angiography (AngioCT) was performed, showing signs of arterial embolization to both limbs, right internal iliac artery, and superior mesenteric artery. Faced with the threat of limb loss and the absence of signs and symptoms of visceral ischemia, the patient underwent full anticoagulation and RLL thromboembolectomy and tricompartmental fasciotomy. He was discharged after 7 days of hospitalization and demonstrated no other signs and symptoms of COVID-19, following outpatient follow-up. DISCUSSION: COVID-19 is associated with high risk of thrombotic complications being related to the clinical severity of the patient, with few studies that show symptoms of sudden pain in the lower limb without other complaints. CONCLUSION: Individuals infected with COVID-19 are at risk for arterial thromboembolic events, and knowledge of such cases is essential in order to create specific protocols for prophylaxis of thrombotic events in these patients, in addition to increasing the suspicion of infection in individuals with acute arterial occlusion, mostly during pandemic times.

Adenoid Cystic Carcinoma of the Trachea: A Case Report.

BACKGROUND Adenoid cystic carcinoma of trachea (ACCT) is an unusual low-grade tumor from the tracheal and bronchial wall glands. The histological structure and biological behavior of ACCT are similar to that of tumors found in the salivary glands. ACCT occurs most commonly in the upper trachea, being found in the articular cartilage in the posterior aspect of the trachea. CASE REPORT We describe the case of a 62-year-old male ex-smoker 25 years/pack (abstinence 20 years ago), who began with mild dyspnea 2 years ago, with intense evolution and cough. He was evaluated as an outpatient and was treated for sinusitis and later bronchitis after pulmonary function tests. With the worsening of the aforementioned symptoms, he sought prompt care, with hospitalization and computed tomography (CT) of the chest being indicated, showing an expansive lesion in the anterior wall of the trachea with an extension of approximately 3.1 cm, ending at the level of the carina, measuring 3.4×2.8 cm, with moderate stenosis of the tracheal lumen, with an exophytic component to the mediastinum. Bronchoscopy of the lesion was done, and later immunohistochemistry showed a probable pleomorphic adenoma. However, in a new analysis, after the removal of the surgical specimen, it was observed that it was a ACCT. CONCLUSIONS ACCT is a rare tumor that should be diagnosed as soon as possible in order to ensure its best prognosis. Moreover, it is evident that the analysis of the surgical specimen is sovereign to immunohistochemistry with regard to histological typing.

Video-assisted thoracic sympathectomy: literature review. / Simpatectomia torácica por videotoracoscopia: revisão da literatura.

Thoracic sympathectomy has been effective in relieving hyperhidrosis in several patients, with quality of life improvement. The knowledge of the clinical picture of each patient, as well as the possible postoperative complications, are fundamental to obtain good results. Thus, we performed a review of articles from the PubMed database published between 2005 and 2019 that presented, as the main topic, thoracoscopy sympathectomy for the treatment of hyperhidrosis, with the objective of evaluating the current state of art referring to postoperative quality of life, surgical time and its complications. From this analysis, we verified the importance of the level of sympathetic ganglion chain section in relation to results. The complication, although occurring, did not reduced the postoperative level of satisfaction or patients' quality of life.

A simpatectomia toracoscópica mostrou-se eficaz no alívio da hiperidrose em diversos pacientes, com melhora da qualidade de vida. O conhecimento do quadro clínico de cada paciente, assim como, as possíveis complicações pós-operatórias, são fundamentais para a obtenção de bons resultados. Deste modo, foi realizada uma revisão na base de dados PubMed de artigos publicados entre 2005 e 2019 que apresentavam como temática principal a simpatectomia realizada por videotoracoscopia para o tratamento da hiperidrose, com o objetivo de avaliar o atual estado da arte referente à qualidade de vida pós-operatória, o tempo de cirurgia e as suas complicações. A partir desta análise, verificou-se a importância do nível de secção da cadeia ganglionar simpática em relação aos resultados. As complicações, apesar de ocorrerem, não reduziram o nível de satisfação e qualidade de vida pós-operatória dos pacientes.

Simpatectomia torácica por videotoracoscopia: revisão da literatura / Video-assisted thoracic sympathectomy: literature review

RESUMO A simpatectomia toracoscópica mostrou-se eficaz no alívio da hiperidrose em diversos pacientes, com melhora da qualidade de vida. O conhecimento do quadro clínico de cada paciente, assim como, as possíveis complicações pós-operatórias, são fundamentais para a obtenção de bons resultados. Deste modo, foi realizada uma revisão na base de dados PubMed de artigos publicados entre 2005 e 2019 que apresentavam como temática principal a simpatectomia realizada por videotoracoscopia para o tratamento da hiperidrose, com o objetivo de avaliar o atual estado da arte referente à qualidade de vida pós-operatória, o tempo de cirurgia e as suas complicações. A partir desta análise, verificou-se a importância do nível de secção da cadeia ganglionar simpática em relação aos resultados. As complicações, apesar de ocorrerem, não reduziram o nível de satisfação e qualidade de vida pós-operatória dos pacientes.

ABSTRACT. Thoracic sympathectomy has been effective in relieving hyperhidrosis in several patients, with quality of life improvement. The knowledge of the clinical picture of each patient, as well as the possible postoperative complications, are fundamental to obtain good results. Thus, we performed a review of articles from the PubMed database published between 2005 and 2019 that presented, as the main topic, thoracoscopy sympathectomy for the treatment of hyperhidrosis, with the objective of evaluating the current state of art referring to postoperative quality of life, surgical time and its complications. From this analysis, we verified the importance of the level of sympathetic ganglion chain section in relation to results. The complication, although occurring, did not reduced the postoperative level of satisfaction or patients' quality of life.

Mini-thoracostomy with vacuum-assisted closure: a minimally invasive alternative to open-window thoracostomy.

Thoracostomy is a common treatment option for patients with stage III pleural empyema who do not tolerate pulmonary decortication. However, thoracostomy is considered mutilating because it involves a thoracic stoma, the closure of which can take years or require further surgery. A new, minimally invasive technique that uses the vacuum-assisted closure has been proposed as an alternative to thoracostomy. This study aims to analyze the safety and effectiveness of mini-thoracostomy with vacuum-assisted closure in an initial sample of patients.

Mini-thoracostomy with vacuum-assisted closure: a minimally invasive alternative to open-window thoracostomy / Minipleurostomia com curativo a vácuo: uma opção minimamente invasiva a pleurostomia

ABSTRACT Thoracostomy is a common treatment option for patients with stage III pleural empyema who do not tolerate pulmonary decortication. However, thoracostomy is considered mutilating because it involves a thoracic stoma, the closure of which can take years or require further surgery. A new, minimally invasive technique that uses the vacuum-assisted closure has been proposed as an alternative to thoracostomy. This study aims to analyze the safety and effectiveness of mini-thoracostomy with vacuum-assisted closure in an initial sample of patients.

RESUMO A pleurostomia é uma opção frequente de tratamento para pacientes com empiema pleural fase III que não toleram decorticação pulmonar. Todavia, esse tratamento é considerado mutilante por envolver a confecção de um stoma torácico, que pode demorar anos para se fechar ou requerer nova cirurgia. Descreveu-se recentemente uma técnica minimamente invasiva que associa uso intrapleural de curativo a vácuo como opção a pleurostomia. A presente comunicação objetiva demonstrar o resultado de uma série inicial de pacientes tratados com a minipleurostomia associada ao uso de curativo a vácuo no que tange a sua efetividade e segurança.

Mediastinal ganglionar tuberculosis postcardiac transplantation.

The diagnosis and treatment of tuberculosis (TB) in transplanted receivers presents several challenges. TB is an opportunistic infection with high morbidity and mortality in solid organs of transplanted patients, therefore, the diagnosis difficulties. A case of a 30-year-old male, heart transplanted patient, who after being submitted to mediastinoscopy, obtained a result of lymph node TB.