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1.
In Vivo ; 34(4): 2073-2078, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606185

RESUMO

BACKGROUND/AIM: Association between cervical cancer and uterine prolapse represents a scarce eventuality. This is a case series of 11 patients diagnosed with different stages of cervical cancer in association with uterine prolapse. PATIENTS AND METHODS: Between 2014 and 2020, 11 patients were diagnosed with cervical cancer on prolapsed uterine cervix. RESULTS: The mean age of patients at the time of uterine cervix diagnosis was 68 years. In six cases, the first intent treatment was surgery, while in the remaining five cases it consisted of radio-chemotherapy, followed by radical surgery. The perioperative and postoperative outcomes were compared to those reported in a similar series of patients diagnosed in similar stages of the disease, but in the absence of uterine prolapse, no significant differences being encountered. CONCLUSION: Although it represents an unusual situation, malignant transformation of the uterine cervix might be encountered even in cases presenting uterine prolapse. In such cases, the therapeutic strategy should be tailored according to the stage of the disease.

2.
In Vivo ; 34(4): 2187-2191, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606203

RESUMO

BACKGROUND/AIM: The presence of "omental cake" has been considered since long as a negative prognostic factor in patients diagnosed with advanced-stage ovarian cancer. The aim of this paper was to study the impact of "omental cake" presence on the perioperative outcomes in advanced-stage ovarian cancer. PATIENTS AND METHODS: Between 2015 and 2020, 85 patients were submitted to surgery for advanced-stage ovarian cancer. RESULTS: Among cases diagnosed with "omental cake" the rate of complete cytoreduction was significantly diminished when compared to cases in which this entity was not revealed. In the meantime, the presence of omental cake among cases in which complete debulking was achievable was significantly associated with a higher number of digestive resections when compared to the other cases submitted to surgery and in which tumoral transformation of the omentum was encountered. CONCLUSION: The presence of "omental cake" is associated with a higher rate of incomplete resections. However, in cases in which complete debulking was achieved, the presence of omental cake was associated with a significantly higher number of digestive tract resections.

3.
In Vivo ; 34(3): 1527-1531, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32354958

RESUMO

BACKGROUND/AIM: Gastroenteropancreatic neuro-endocrine carcinomas represent poorly differentiated neoplasms with a high capacity of spreading inducing the development of distant metastases. In such cases debulking surgery seems to offer a good chance for survival especially in well and moderately differentiated lesions. The aim of this study was to report the case of a 48-year-old patient submitted to surgery for moderately differentiated neuroendocrine gastric carcinoma with distant metastases. CASE REPORT: The patient was initially investigated for hematemesis and weight loss and was diagnosed with a lesser curvature gastric tumor in association with liver and peritoneal metastases. Due to the extent of the disease, the patient was initially submitted to neoadjuvant chemotherapy followed by surgery with radical intent. At the time of surgery subtotal gastrectomy en bloc with total omentectomy, peritonectomy, cholecystectomy and atypical liver resection were performed. Moreover, the two ovaries presented large tumoral masses so total hysterectomy with bilateral adnexectomy was performed. The histopathological studies confirmed the presence of a moderately differentiated neuroendocrine gastric carcinoma with negative resection margins. CONCLUSION: Multiple visceral resections might be needed in order to maximize the debulking effort in metastatic gastric neuroendocrine carcinomas.

4.
Thorac Cardiovasc Surg ; 68(6): 516-519, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31476773

RESUMO

INTRODUCTION: This article presents a series of patients on which the transcervical approach was used to close a left-sided postpneumonectomy fistula. MATERIALS AND METHODS: The series comprises nine patients with a left pneumonectomy performed for a tuberculosis-related suppurative disease in five cases and for lung cancer in the remaining four. This procedure can be performed under certain conditions, the most important one being the length of the bronchial stump, which should be at least 1 cm, ideally 1.5 cm. The transcervical stump closure was successfully achieved in all patients, having been more technically demanding in cancer cases with previous lymphadenectomy. The postpneumonectomy infected cavity was subsequently treated. RESULTS: The follow-up continued for at least 1 year; one individual from the cancer patients group died from an uncontrolled sepsis during the postoperative period, another one died 17 months later from metastatic cancer and two of them are alive, with no signs of neoplastic or infectious relapse 15 and 37 months, respectively, after the cervical procedure. One patient from the suppurative disease group had a relapse of the fistula 2 months after surgery, requiring additional surgical procedures to deal with this issue; all the other patients are alive, with no signs of recurrence. CONCLUSIONS: The transcervical approach is a very suitable maneuver in selected patients with a bronchial stump at least 1 cm long, ideally 1.5 cm.

5.
Oncotarget ; 10(19): 1760-1774, 2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30956756

RESUMO

The development of cancer is driven by the accumulation of many oncogenesis-related genetic alterations and tumorigenesis is triggered by complex networks of involved genes rather than independent actions. To explore the epistasis existing among oncogenesis-related genes in lung cancer development, we conducted pairwise genetic interaction analyses among 35,031 SNPs from 2027 oncogenesis-related genes. The genotypes from three independent genome-wide association studies including a total of 24,037 lung cancer patients and 20,401 healthy controls with Caucasian ancestry were analyzed in the study. Using a two-stage study design including discovery and replication studies, and stringent Bonferroni correction for multiple statistical analysis, we identified significant genetic interactions between SNPs in RGL1:RAD51B (OR=0.44, p value=3.27x10-11 in overall lung cancer and OR=0.41, p value=9.71x10-11 in non-small cell lung cancer), SYNE1:RNF43 (OR=0.73, p value=1.01x10-12 in adenocarcinoma) and FHIT:TSPAN8 (OR=1.82, p value=7.62x10-11 in squamous cell carcinoma) in our analysis. None of these genes have been identified from previous main effect association studies in lung cancer. Further eQTL gene expression analysis in lung tissues provided information supporting the functional role of the identified epistasis in lung tumorigenesis. Gene set enrichment analysis revealed potential pathways and gene networks underlying molecular mechanisms in overall lung cancer as well as histology subtypes development. Our results provide evidence that genetic interactions between oncogenesis-related genes play an important role in lung tumorigenesis and epistasis analysis, combined with functional annotation, provides a valuable tool for uncovering functional novel susceptibility genes that contribute to lung cancer development by interacting with other modifier genes.

6.
Nat Commun ; 9(1): 3927, 2018 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-30254314

RESUMO

Lung cancer has several genetic associations identified within the major histocompatibility complex (MHC); although the basis for these associations remains elusive. Here, we analyze MHC genetic variation among 26,044 lung cancer patients and 20,836 controls densely genotyped across the MHC, using the Illumina Illumina OncoArray or Illumina 660W SNP microarray. We impute sequence variation in classical HLA genes, fine-map MHC associations for lung cancer risk with major histologies and compare results between ethnicities. Independent and novel associations within HLA genes are identified in Europeans including amino acids in the HLA-B*0801 peptide binding groove and an independent HLA-DQB1*06 loci group. In Asians, associations are driven by two independent HLA allele sets that both increase risk in HLA-DQB1*0401 and HLA-DRB1*0701; the latter better represented by the amino acid Ala-104. These results implicate several HLA-tumor peptide interactions as the major MHC factor modulating lung cancer susceptibility.


Assuntos
Mapeamento Cromossômico , Predisposição Genética para Doença/genética , Neoplasias Pulmonares/genética , Complexo Principal de Histocompatibilidade/genética , Grupo com Ancestrais do Continente Asiático/genética , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Frequência do Gene , Predisposição Genética para Doença/etnologia , Genótipo , Antígenos HLA/genética , Humanos , Neoplasias Pulmonares/etnologia , Masculino , Pessoa de Meia-Idade , Peptídeos/genética , Polimorfismo de Nucleotídeo Único
7.
EBioMedicine ; 32: 93-101, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29859855

RESUMO

Recent technological advancements have permitted high-throughput measurement of the human genome, epigenome, metabolome, transcriptome, and proteome at the population level. We hypothesized that subsets of genes identified from omic studies might have closely related biological functions and thus might interact directly at the network level. Therefore, we conducted an integrative analysis of multi-omic datasets of non-small cell lung cancer (NSCLC) to search for association patterns beyond the genome and transcriptome. A large, complex, and robust gene network containing well-known lung cancer-related genes, including EGFR and TERT, was identified from combined gene lists for lung adenocarcinoma. Members of the hypoxia-inducible factor (HIF) gene family were at the center of this network. Subsequent sequencing of network hub genes within a subset of samples from the Transdisciplinary Research in Cancer of the Lung-International Lung Cancer Consortium (TRICL-ILCCO) consortium revealed a SNP (rs12614710) in EPAS1 associated with NSCLC that reached genome-wide significance (OR = 1.50; 95% CI: 1.31-1.72; p = 7.75 × 10-9). Using imputed data, we found that this SNP remained significant in the entire TRICL-ILCCO consortium (p = .03). Additional functional studies are warranted to better understand interrelationships among genetic polymorphisms, DNA methylation status, and EPAS1 expression.


Assuntos
Adenocarcinoma/genética , Fatores de Transcrição Hélice-Alça-Hélice Básicos/genética , Carcinoma Pulmonar de Células não Pequenas/genética , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Neoplasias Pulmonares/genética , Adenocarcinoma/patologia , Adenocarcinoma de Pulmão , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Metilação de DNA/genética , Feminino , Regulação Neoplásica da Expressão Gênica , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único
8.
Chirurgia (Bucur) ; 113(1): 95-100, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29509535

RESUMO

Gastric pull-up is the most commonly used procedure for esophageal replacement in both malignant and benign conditions. In our article we compare the differences in mortality and morbidity between thoracic anastomosis and cervical anastomosis during gastric pull-up. The study group comprised of 126 patients - 58 patients (56%) with cervical anastomosis and 68 patients (64%) with thoracic anastomosis. The overall mortality in the study group was 5.55% (7 patients), while the overall morbidity was higher at 28%. There were no significant differences between the two subgroups regarding mortality and morbidity, although the rate of anastomotic leakage was higher in the cervical subgroup (13.8% vs 1.5%). We recommend performing thoracic anastomosis during gastric pull-up whenever the location of the lesion allows it, since the procedure is safe, relatively easy to master and it shortens operating time by excluding the cervical approach.


Assuntos
Anastomose Cirúrgica , Esofagectomia , Esofagoplastia/métodos , Estômago/transplante , Idoso , Anastomose Cirúrgica/métodos , Esofagectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Resultado do Tratamento
9.
Carcinogenesis ; 39(3): 336-346, 2018 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-29059373

RESUMO

Non-small cell lung cancer is the most common type of lung cancer. Both environmental and genetic risk factors contribute to lung carcinogenesis. We conducted a genome-wide interaction analysis between single nucleotide polymorphisms (SNPs) and smoking status (never- versus ever-smokers) in a European-descent population. We adopted a two-step analysis strategy in the discovery stage: we first conducted a case-only interaction analysis to assess the relationship between SNPs and smoking behavior using 13336 non-small cell lung cancer cases. Candidate SNPs with P-value <0.001 were further analyzed using a standard case-control interaction analysis including 13970 controls. The significant SNPs with P-value <3.5 × 10-5 (correcting for multiple tests) from the case-control analysis in the discovery stage were further validated using an independent replication dataset comprising 5377 controls and 3054 non-small cell lung cancer cases. We further stratified the analysis by histological subtypes. Two novel SNPs, rs6441286 and rs17723637, were identified for overall lung cancer risk. The interaction odds ratio and meta-analysis P-value for these two SNPs were 1.24 with 6.96 × 10-7 and 1.37 with 3.49 × 10-7, respectively. In addition, interaction of smoking with rs4751674 was identified in squamous cell lung carcinoma with an odds ratio of 0.58 and P-value of 8.12 × 10-7. This study is by far the largest genome-wide SNP-smoking interaction analysis reported for lung cancer. The three identified novel SNPs provide potential candidate biomarkers for lung cancer risk screening and intervention. The results from our study reinforce that gene-smoking interactions play important roles in the etiology of lung cancer and account for part of the missing heritability of this disease.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/etiologia , Carcinoma Pulmonar de Células não Pequenas/genética , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/genética , Fumar/efeitos adversos , Estudos de Casos e Controles , Grupo com Ancestrais do Continente Europeu , Interação Gene-Ambiente , Predisposição Genética para Doença/genética , Estudo de Associação Genômica Ampla , Genótipo , Humanos , Polimorfismo de Nucleotídeo Único
10.
Chirurgia (Bucur) ; 112(6): 696-704, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29288612

RESUMO

Introduction: Postintubation tracheoesophageal fistula is a severe complication occurring under certain conditions in patients that require prolonged mechanical ventilation. MATERIAL AND METHODS: This article focuses on a sample of 11 patients with postintubation tracheoesophageal fistula, operated in our department between 2005 and 2015. The anterior approach with tracheal resection was performed in 10 of these patients, while an atypical surgical technique was preferred in a case involving a large-sized fistula. Three of these patients were subject to surgery while still on the ventilator, in order to help weaning them from mechanical ventilation. Two patients were operated following a relapse of the fistula, after attempts of closing it in other surgical units. Results: Two patients (of those who were still on mechanical ventilation) died from intubation-related complications that persisted after tracheal resection (anastomotic dehiscence with mediastinitis and tracheoarterial fistula in the brachiocephalic arterial trunk). The nine remaining patients improved, with their airways restored and having regained normal deglutition. Conclusions: The surgical approach of this pathology is successful in surgical units that are specialised in tracheal and oesophageal surgery. Adequately timing the surgery is crucial for a good outcome.


Assuntos
Esôfago/cirurgia , Intubação Intratraqueal/efeitos adversos , Traqueia/cirurgia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/cirurgia , Adulto , Anastomose Cirúrgica/efeitos adversos , Esofagoplastia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Estudos Retrospectivos , Taxa de Sobrevida , Fístula Traqueoesofágica/diagnóstico , Fístula Traqueoesofágica/mortalidade , Resultado do Tratamento
11.
Rom J Morphol Embryol ; 58(1): 287-291, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28523334

RESUMO

AIM: Doege-Potter syndrome is a rare condition consisting of a mesenchymal tumor, either benign or malignant, accompanied by severe hypoglycemia. The syndrome was first described independently by two American physicians, Karl Walter Doege (1867-1932) and Roy Pilling Potter (1879-1968), in 1930, but it was not before 1988 that it was associated with non-islet cell tumor production of insulin growth factor (IGF) that induces hypoglycemia as a paraneoplastic syndrome. CASE PRESENTATION: We present the case of a 61-year-old woman with severe hypoglycemia that induced seizures. On the general check-up, a massive tumor occupying the lower part of left hemi-thorax was discovered. Initially, corticosteroids, glucose i.v. and high carbohydrate diet managed to prevent the severe blood glucose drop. Surgery exposed a massive well-defined pleural tumor. After surgical removal, blood glucose stabilized. Histological examination confirmed the fibrous tumor that proved to be malignant on immunochemistry. DISCUSSION: The authors discuss other cases reported in the literature of this rare condition and its pathogenic mechanisms, the presented case being the first reported in Romania. CONCLUSIONS: The clinician should be aware of the possible existence of a pleural tumor in a patient presenting an unexplained hypoglycemia because the surgical removal of the tumor can solve the clinical manifestations.


Assuntos
Anormalidades Congênitas/diagnóstico , Hipoglicemia/complicações , Nefropatias/congênito , Rim/anormalidades , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/patologia , Anormalidades Congênitas/diagnóstico por imagem , Feminino , Humanos , Imuno-Histoquímica , Rim/diagnóstico por imagem , Nefropatias/diagnóstico , Nefropatias/diagnóstico por imagem , Pessoa de Meia-Idade , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/cirurgia , Radiografia Torácica , Tomografia Computadorizada por Raios X
12.
Pneumologia ; 64(2): 20-2, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26506669

RESUMO

Pulmonary metastasectomy has been widely accepted by thoracic surgeons and is applied to the treatment of a variety of histologies, but the evidence that the patient may benefit from lung metastasectomy is not yet elucidated and the best way of integrating oncologic therapies (induction or adjuvant chemotherapy or radiotherapy) with surgical resection are still unknown. When there is no good clinical alternative, the resection of pulmonary metastases can give some patients long-lasting disease free intervals. Patients should be carefully selected on the basis of clinical staging with defined prognostic indicators. In order to obtain suitable results the management of these patients should be based on a multidisciplinary team decision.


Assuntos
Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metastasectomia , Pneumonectomia , Quimioterapia Adjuvante/métodos , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Metástase Linfática/patologia , Invasividade Neoplásica , Pneumonectomia/métodos , Prognóstico , Radioterapia Adjuvante/métodos , Análise de Sobrevida , Resultado do Tratamento
13.
Pneumologia ; 64(2): 41-3, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26506674

RESUMO

Synchronous malignant lesions will always entail treatment related difficulties which would ideally require discussions within a multidisciplinary committee in such a way as to reach the optimal solution for the patient. Presented herewith are two patients suffering from lung cancer and clear cell renal carcinoma contralateral metastases and the treatment alternatives that I have opted for.


Assuntos
Adenocarcinoma/diagnóstico , Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Neuroendócrino/diagnóstico , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Humanos , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/terapia , Pneumonectomia/métodos , Resultado do Tratamento
14.
Ann Thorac Surg ; 98(4): 1496-8, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25282231

RESUMO

There is no consensus on the ideal treatment for esophageal perforation and on the maximal extent of esophageal disruption amenable to primary repair. The effect of extensive esophageal injury on postoperative esophageal motility is also unknown. We report the case of a longitudinal iatrogenic esophageal laceration extending from the hypopharynx to the cardia in a morbidly obese patient treated with primary repair. The patient exhibited no postoperative esophageal leak or stricture and maintained a preserved esophageal peristalsis on manometry at 3 months. An extensively lacerated esophagus can be repaired primarily while maintaining a normal postoperative function.


Assuntos
Esôfago/lesões , Esôfago/cirurgia , Adulto , Transtornos da Motilidade Esofágica/prevenção & controle , Esôfago/fisiopatologia , Feminino , Humanos , Peristaltismo , Ruptura , Cirurgia Torácica Vídeoassistida
15.
Pneumologia ; 63(2): 122-5, 2014.
Artigo em Romano | MEDLINE | ID: mdl-25241561

RESUMO

Long term complications after colic replacement of the esophagus are well known and their managment is known as being difficult, due to multiple associated comorbidities; we present the case of a 26-year-old patient with multiple late complications after a coloesophagoplaty for lye ingestion during childhood. The patient finally died despite all the eforts of treatement during a prolonged hospitalisation. We will try to analyse the key moments on patient's evolution and discuss other possible options in this case.


Assuntos
Queimaduras Químicas/complicações , Cáusticos/efeitos adversos , Colo/transplante , Estenose Esofágica/etiologia , Estenose Esofágica/cirurgia , Esofagoplastia/efeitos adversos , Lixívia/efeitos adversos , Adulto , Antibacterianos/uso terapêutico , Queimaduras Químicas/etiologia , Nanismo/etiologia , Empiema Pleural/diagnóstico , Empiema Pleural/etiologia , Empiema Pleural/terapia , Estenose Esofágica/diagnóstico , Esofagoplastia/métodos , Evolução Fatal , Gastrostomia , Humanos , Hipoparatireoidismo/complicações , Hipotireoidismo/complicações , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/etiologia , Abscesso Pulmonar/terapia , Masculino , Pneumonectomia , Reoperação , Fatores de Risco , Fatores de Tempo
16.
Pneumologia ; 62(3): 146-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24273997

RESUMO

Bronchial ruptures due to blunt chest traumas are rarely encountered injuries and frequently late diagnosed. Once the diagnostic is established by bronchoscopy surgical treatment is mandatory and usually, the results are very good. In order to conserve as much as possible lung parenchyma minimal possible resection is required. We present four cases managed in our department by means of main bronchial sleeve resection--two on the right side and two on the left side--with good outcome. We were able to save the entire lung in all four cases despite long-term atelectasis.


Assuntos
Acidentes de Trânsito , Brônquios/lesões , Broncopatias/diagnóstico , Diagnóstico Tardio , Traumatismo Múltiplo/complicações , Ferimentos não Penetrantes/complicações , Adulto , Broncopatias/etiologia , Broncopatias/cirurgia , Broncoscopia , Constrição Patológica , Seguimentos , Humanos , Masculino , Traumatismo Múltiplo/etiologia , Toracoscopia , Resultado do Tratamento , Ferimentos não Penetrantes/etiologia
17.
Pneumologia ; 62(4): 236-8, 2013.
Artigo em Romano | MEDLINE | ID: mdl-24734358

RESUMO

Role of surgery in small cell lung cancer Small-cell lung cancer (SCLC) is a very aggressive neuroendocrine carcinoma that accounts for approximately 10-15% of all lung cancer cases. This histological subtype is a distinct entity with biological and oncological features differing from non-small cell lung cancer (NSCLC). Standard treatment is performed using systemic chemotherapy, and surgery in association with chemotherapy and radiotherapy may be indicated for a minor proportion of cases with limited disease. Since the results after surgical intervention in patients with very early disease are comparable to those for NSCLC, careful staging is required, especially in terms of nodal involvement- use of PET-CT EUS, EBUS and/ or mediastinoscopy is recommended. However, only two randomized control studies have examined the efficacy of surgery in SCLC, and both yielded negative results and are out of date. We review here several studies concerning surgery for SCLC and discuss the results from a practical standpoint.


Assuntos
Neoplasias Pulmonares/cirurgia , Carcinoma de Pequenas Células do Pulmão/cirurgia , Quimiorradioterapia , Medicina Baseada em Evidências , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Estadiamento de Neoplasias , Cuidados Pós-Operatórios , Ensaios Clínicos Controlados Aleatórios como Assunto , Romênia/epidemiologia , Carcinoma de Pequenas Células do Pulmão/epidemiologia , Carcinoma de Pequenas Células do Pulmão/patologia , Carcinoma de Pequenas Células do Pulmão/terapia , Resultado do Tratamento
18.
Pneumologia ; 61(3): 168-70, 2012.
Artigo em Romano | MEDLINE | ID: mdl-23173378

RESUMO

Hydatid disease remains endemic in many parts of the world, most notably the Mediterranean region, Australia, New Zealand, the Middle East, and South America. Plurivisceral echinococcosis is defined as the concomitant or successive presence of hydatidosis in more than one internal organ. It has been noticed that the number of cases with multi-organ localizations and multiple cysts has increased in the last years. As the surgery of plurivisceral echinococcosis remains one of the challenges for the medical world, in this article we present our experience during 2000-2007 with this disease, followed by a case report of one of the most special cases of echinococcosis, discussing the principles of treatment, along with a new classification of this disease. Plurivisceral echinococcosis is associated with higher postoperative morbidity and mortality than uncomplicated cysts, related to organ involvement and surgical treatment. In the sequential approach we recommend resolving first surgically the complicated cysts or those at risk. In the thoracic and abdominal locations, the thoracic cysts will be approached first. The treatment methods will be as conservative as possible. Management of pulmonary and hepatic cysts (diaphragmatic side) simultaneously through the thoracic route is convenient and should be encouraged in patients because this prevents a second operation.


Assuntos
Equinococose Hepática/cirurgia , Equinococose Pulmonar/cirurgia , Hepatectomia , Pneumonectomia , Adulto , Animais , Anticestoides/uso terapêutico , Equinococose Hepática/classificação , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/tratamento farmacológico , Equinococose Pulmonar/classificação , Equinococose Pulmonar/diagnóstico por imagem , Equinococose Pulmonar/tratamento farmacológico , Feminino , Seguimentos , Hepatectomia/métodos , Humanos , Pneumonectomia/métodos , Radiografia , Resultado do Tratamento
19.
Pneumologia ; 61(1): 44-7, 2012.
Artigo em Romano | MEDLINE | ID: mdl-22545489

RESUMO

Bronchopleural fistulas and empyema are the most devastating complications after lung resection. The optimal management remains a major subject of controversy for thoracic surgeons over the wide variety of therapeutic approaches, none suitable for all patients. In 1996 Azorin et al. reported the first successful mediastinoscopic reclosure by stapling of an insufficient bronchial stump after left pneumonectomy using video-assisted mediastinoscopy. The authors report the first national case of left-sided bronchopleural fistula closure using video-assisted mediastinoscopy, describing their experience with this technique. A 40 years old woman presented to our unit with left thorax empyema after having undergone left pneumonectomy for TB destructed lung with aspergillosis in another hospital. Bronchoscopy revealed a 15 mm long bronchial stump with insufficiency. Despite all advances made over the last decades in perioperative management, bronchopleural fistula after pneumonectomy remains a significant problem in thoracic surgery. Video-mediastinoscopy is an alternative to the open methods as it allows approaching the bronchial stump via the mediastinum. The dissection of the trachea through its natural route enables bronchial mobilization. Positive factors influencing our decision were the virgin mediastinum with no surgical dissection and no radiation therapy applied. The mediastinoscopic approach for bronchial stump closure after pneumonectomy is a novel option in highly selected patients. This is our choice for a long (at least 10 mm) bronchial stump because its morbidity is minimal compared with transpericardial sternotomy or a transthoracic approach. It warrants minimal surgical trauma; however, skilled surgeons with experience in mediastinoscopy have to be prepared to convert to an open technique immediately.


Assuntos
Fístula Brônquica/cirurgia , Empiema Pleural/cirurgia , Hospedeiro Imunocomprometido , Mediastinoscopia/métodos , Pneumonectomia/efeitos adversos , Aspergilose Pulmonar/cirurgia , Tuberculose Pulmonar/cirurgia , Cirurgia Vídeoassistida , Adulto , Fístula Brônquica/etiologia , Empiema Pleural/etiologia , Feminino , Humanos , Mediastinoscopia/instrumentação , Aspergilose Pulmonar/complicações , Reoperação , Resultado do Tratamento , Tuberculose Pulmonar/complicações , Cirurgia Vídeoassistida/métodos
20.
Thorac Surg Clin ; 22(2): 139-53, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22520281

RESUMO

The thoracic lymphatic system is one of the most complex and poorly understood systems of the human body, and much is still to be learned, especially in lymphatic physiology. Knowledge of the normal anatomy of this system as well as of its variations is nevertheless important for thoracic surgeons investigating and treating patients with lung or esophageal neoplasms.


Assuntos
Sistema Linfático/anatomia & histologia , Sistema Linfático/fisiologia , Tórax/anatomia & histologia , Humanos , Neoplasias Pulmonares/patologia , Linfa/fisiologia , Vasos Linfáticos/anatomia & histologia , Vasos Linfáticos/fisiologia , Ilustração Médica , Estadiamento de Neoplasias/métodos
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