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1.
Medicine (Baltimore) ; 100(14): e25371, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832122

RESUMO

INTRODUCTION: Early acute massive pulmonary thrombosis embolism (PTE) after lung cancer surgery is one of the most fatal surgical complications. It is often accompanied by shock and hypotension, with high mortality rate. Due to surgical wounds, patients with early acute massive PTE after lung cancer surgery have a high risk of thrombolytic bleeding, which renders treatment more challenging and there is currently no standard protocol on how to safely and effectively treat these patients in the clinic. PATIENT CONCERNS: A 66-year-old woman after video-assisted thoracoscopic surgery for lung cancer, experienced sudden severe dyspnea, shock and hypotension with high D-Dimer, changed electrocardiogram (ECG), right ventricular dilatation, severe tricuspid regurgitation, and raised pulmonary arterial pressure on ultrasonic cardiogram (UCG), thromboses found on Ultrasonography of lower extremity vein. DIAGNOSIS: Because of her clinical manifestations and results of bedside auxiliary examinations, the patient was finally diagnosed with acute high-risk PTE after lung cancer surgery. INTERVENTIONS: 1.5 hours after onset of symptoms, thrombolysis using a continuous micropump infusion of 20,000 units/kg urokinase into the peripheral vein for 2 hours was initiated for this patient. OUTCOMES: The patient died of massive hemorrhage after thrombolysis. LESSONS: Treatment for patients with early acute PTE after lung cancer surgery is challenging due to a high risk of thrombolytic bleeding at the surgical site. Real-time monitoring of vital signs during thrombolysis and catheter-directed thrombolysis are recommended for these patients, in order to use the minimum drug dosage for quick curative effects and a low risk of bleeding.


Assuntos
Neoplasias Pulmonares/cirurgia , Embolia Pulmonar/diagnóstico , Terapia Trombolítica/efeitos adversos , Trombose/diagnóstico por imagem , Doença Aguda , Idoso , Evolução Fatal , Feminino , Hemorragia/induzido quimicamente , Humanos , Complicações Pós-Operatórias , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Cirurgia Torácica Vídeoassistida/métodos , Terapia Trombolítica/métodos , Trombose/complicações , Ultrassonografia/métodos , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico
2.
BMC Surg ; 21(1): 172, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33785015

RESUMO

BACKGROUND: Systematic nodal dissection plays a crucial role in improving survival and staging in resectable non-small cell lung cancer (NSCLC) patients but at the cost of increasing the occurrence of recurrent laryngeal nerve injury. Technology should be improved to protect the recurrent laryngeal nerve (RLN) during surgery. METHODS: NSCLC patients who underwent video-assisted thoracic surgery (VATS) surgical treatment by the same surgeon at our hospital from January 2016 to December 2017 were included as the research subjects and were divided into an energy-device group and a non-energy-device group. Their procedures included anatomic pulmonary resection, normative N1 dissection, and systemic N2 dissection. RESULTS: The rate of metastatically involved recurrent laryngeal nerve lymph nodes (RLNLNs) was 5.19% (39/752). Dissection device, side of primary, FEV1, operative time and BMI were independent predictors of recurrent laryngeal nerve injury (RLNI) (hazard ratio (HR) = 3.576, 95% confidence interval (CI): 1.490-8.583, P = 0.004; HR = 0.175, 95% CI: 0.072-0.424, P = < 0.001; HR = 3.008, 95% CI: 1.30-6.927, P = 0.010; HR = 0.328, 95% CI: 0.136-0.794, P = 0.013; HR = 0.344, 95%CI: 0.147-0.801, P = 0.013, respectively). Patients in the non-energy-device group had significantly less RLNI than the energy-device group (P = 0.016) and nearly half of the non-thermal RLNI recovered in 2 weeks (P = 0.025) whereas most thermal RLNI required 3 months for recovery. CONCLUSIONS: Every station of RLNLN had some degree of cancer metastasis in NSCLC patients and when dissecting RLNLNs, dissection device was an independent and artificially controlled predictor of RLNI. Using a non-energy device is a feasible method to protect the RLN as well as an improved recovery time of RLNI.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Linfonodos , Nervo Laríngeo Recorrente , Cirurgia Torácica Vídeoassistida , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Estudos de Viabilidade , Humanos , Neoplasias Pulmonares/cirurgia , Linfonodos/patologia , Linfonodos/cirurgia , Nervo Laríngeo Recorrente/patologia , Nervo Laríngeo Recorrente/cirurgia , Cirurgia Torácica Vídeoassistida/métodos
3.
Medicine (Baltimore) ; 100(6): e24700, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578606

RESUMO

RATIONALE: Double primary lung cancer (DPLC) is a relatively rare type of lung cancers. According to whether the diagnosis interval between lesions is more than 6 months, it can be divided into synchronous DPLC (sDPLC) and metachronous DPLC (mDPLC). Here, we describe a case of sDPLC in which one of the components is a rare colloid adenocarcinoma (CA). PATIENT CONCERNS: A 69-year-old male was admitted to the hospital due to chest distress and shortness of breath for 1 year, getting worse in the last 15 days. DIAGNOSIS: Both HE staining and IHC supported the diagnosis of CA in the right lower lobe and moderately differentiated squamous cell carcinoma in the right upper lobe. INTERVENTIONS: The patient was treated with 3 cycles of adjuvant chemotherapy with pemetrexed and lobaplatin after the right upper lobectomy, wedge resection of the right lower lobe and lymph node dissection under video-assisted thoracoscope. OUTCOMES: Our plan was to follow him up with general physical examination, chest-abdomen CT and serum tumor markers every 6 months for 2 years. The patient was still alive until the last follow-up in November 2020. LESSONS: CA of the lung is a rare primary lung adenocarcinoma. The diagnosis should be based on the patient's clinical characteristics, imaging examination and pathological characteristics, and also need to be differentiated from other mucinous adenocarcinomas. Interestingly, our patient developed not only a CA in the right lower lobe, but also a moderately differentiated squamous cell carcinoma in the right upper lobe.


Assuntos
Adenocarcinoma Mucinoso/patologia , Adenocarcinoma/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Pulmonares/patologia , Neoplasias Primárias Múltiplas/patologia , Adenocarcinoma/terapia , Adenocarcinoma Mucinoso/metabolismo , Adenocarcinoma Mucinoso/terapia , Assistência ao Convalescente/métodos , Idoso , Biomarcadores Tumorais/sangue , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/terapia , Quimioterapia Adjuvante/métodos , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/metabolismo , Excisão de Linfonodo/métodos , Masculino , Estadiamento de Neoplasias/métodos , Neoplasias Primárias Múltiplas/terapia , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
BMC Surg ; 21(1): 101, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622276

RESUMO

BACKGROUND: A pulmonary arteriovenous fistula (PAVF) is a rare condition that is associated with pulmonary arteriovenous malformation (PAVM). Few reports have described managing PAVMs using uniportal video-assisted thoracoscopic surgery (VATS). CASE PRESENTATION: A 13-year-old child with PAVF in the left inferior pulmonary artery was treated by uniportal VATS with left lower lobectomy. After surgery, hemoptysis did not recur and there were no postoperative complications. Six months after the operation, postoperative review of computerized tomography showed no recrudescence of PAVF. CONCLUSIONS: PAVF is a rare case that should be diagnosed and treated early. 3D- computerized tomography (CT) reconstruction is useful for diagnosis and preoperative assessment. The case shows that PAVF can be managed with uniportal VATS.


Assuntos
Fístula Arteriovenosa , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Cirurgia Torácica Vídeoassistida , Adolescente , Fístula Arteriovenosa/cirurgia , Humanos , Artéria Pulmonar/cirurgia , Veias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida/métodos
5.
Medicine (Baltimore) ; 100(5): e24333, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592879

RESUMO

ABSTRACT: To evaluate the clinical efficiency, feasibility, and safety of computed tomography (CT)-guided trans-scapular coil localization (TSCL) approach to treating scapula-blocked pulmonary nodules (SBPNs).In total, 105 patients with pulmonary nodules underwent CT-guided CL and subsequent video-assisted thoracoscopic surgery (VATS)-guided wedge resection (WR) between January 2016 and July 2020. Six of these patients (5.7%) had SBPNs that led them to undergo CT-guided TSCL. Rates of technical success and localization-related complications were then recorded and analyzed.CT-guided TSCL was associated with a 100% technical success rate, with one coil being placed per patient. The median CT-guided TSCL duration was 15 min. No patients experienced any complications associated with this procedure, and subsequent VATS-guided WR of SBPNs was 100% technically successful. In two patients with invasive adenocarcinoma, additional lobectomy was performed. Median VATS duration and intraoperative blood loss were 120 min and 150 mL, respectively.In summary, these results indicate that CT-guided TSCL could be easily and safely implemented to achieve high success rate when performing the VATS-guided WR of SBPNs.


Assuntos
Nódulos Pulmonares Múltiplos/cirurgia , Radiografia Intervencionista/métodos , Escápula/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
Br J Radiol ; 94(1117): 20200633, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33125260

RESUMO

OBJECTIVE: To develop and validate a CT-based nomogram to predict the occurrence of loculated pneumothorax due to hook wire placement. METHODS: Patients (n = 177) were divided into pneumothorax (n = 72) and non-pneumothorax (n = 105) groups. Multivariable logistic regression analysis was applied to build a clinical prediction model using significant predictors identified by univariate analysis of imaging features and clinical factors. Receiver operating characteristic (ROC) was applied to evaluate the discrimination of the nomogram, which was calibrated using calibration curve. RESULTS: Based on the results of multivariable regression analysis, transfissure approach [odds ratio (OR): 757.94; 95% confidence interval CI (21.20-27099.30) p < 0.0001], transemphysema [OR: 116.73; 95% CI (12.34-1104.04) p < 0.0001], localization of multiple nodules [OR: 8.04; 95% CI (2.09-30.89) p = 0.002], and depth of nodule [OR: 0.77; 95% CI (0.71-0.85) p < 0.0001] were independent risk factors for pneumothorax and were included in the predictive model (p < 0.05). The area under the ROC curve value for the nomogram was 0.95 [95% CI (0.92-0.98)] and the calibration curve indicated good consistency between risk predicted using the model and actual risk. CONCLUSION: A CT-based nomogram combining imaging features and clinical factors can predict the probability of pneumothorax before localization of ground-glass nodules. The nomogram is a decision-making tool to prevent pneumothorax and determine whether to proceed with further treatment. ADVANCES IN KNOWLEDGE: A nomogram composed of transfissure, transemphysema, multiple nodule localization, and depth of nodule has been developed to predict the probability of pneumothorax before localization of GGNs.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida/instrumentação , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nomogramas , Pneumotórax/etiologia , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/instrumentação , Radiografia Intervencionista , Reprodutibilidade dos Testes , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos
7.
Magy Seb ; 73(4): 125-139, 2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310915

RESUMO

Összefoglaló. Bevezetés: A myasthenia gravis javallatával végzett csecsemomirigy-eltávolítás sebésztechnikai szempontból lényegesen megváltozott az elmúlt közel 30 évben. A standard mutétnek számító transsternalis és transcervicalis thymectomia mellett elterjedt a videoasszisztált thoracoscopos sebészeti (VATS), késobb pedig a robot sebészeti megoldás is. Két intézetünkben 2011-2012-ben vezettük be a VATS thymectomiát. Módszer: A többféle technikai megoldás közül a mediastinumot a jobb mellüreg felol megközelíto utat választottuk. Eleinte 3, késobb 2 pontos perimammaris portot készítettünk a thymus elérésére a beteg háton fekvo helyzetében. Minden esetben ultrahangos vágóeszközt alkalmaztunk. Kiterjesztett thymectomiára törekedve a perithymikus zsírszövetet is eltávolítottuk, szélesen megnyitva a bal oldali mellüreget is. A betegek kiválasztásában az átlagos testsúlyú vagy soványabb betegeket részesítettük elonyben. Eredmények: 8 év és 4 hónap alatt 92 beteget mutöttünk a fenti módszerrel thymoma nélküli myasthenia gravis alapbetegséggel. 20 férfi és 72 no. Átlagéletkor 33,1 év (19-75 év). A mutéti ido 35-160 percig terjedt, átlagosan 82,3 perc volt. A tömegesebb mediastinalis zsírszövet néhány betegnél nehezítette a tájékozódást és a maradéktalan eltávolítást. Mutét alatt 4 esetben érsérülés és 3 ellenoldali tüdosérülés következett be. Két konverziót végeztünk (1-1 sternotomia és thoracotomia). Idegsérülés nem történt. Tíz beteg igényelt néhány órás muvi lélegeztetést a mutét után, a többi beteget a mutoasztalon extubáltuk. Reintubáció, tracheostomia, légzési elégtelenség, mutéti halálozás nem volt. Az intenzív ápolási ido átlaga: 1,1 (0-11) nap. A teljes kórházi ápolási ido átlaga: 4,8 (3-15) nap. A drenázsido 1-4 nap, átlagosan 1,16 nap. Két beteg (2,41%) halt meg a mutétet követoen 1 és 5 éven belül. További 81 beteg 12-108 (átlag: 48) hónapos követése során a myastheniás állapotban 21 (25,3%) betegnél komplett, 4 (4,82%) betegnél gyógyszeres remisszió, 20 (24,1%) betegnél minimális manifesztáció, 28 (33,73%) betegnél egyéb javulás volt megállapítható. 4 (4,82%) beteg állapota változatlan maradt, 4 (4,82%) betegé pedig romlott. Következtetés: A VATS thymectomia teljesen új utat jelent a transsternalis módszerben járatos sebészek számára. A tömegesebb mediastinalis zsírszövet nagyon megnehezíti a mutétet. A perioperatív szak nagyon kedvezo a betegek számára, és a késoi eredmények is elfogadhatóak. Kérdéses, hogy a thymus minden esetben maradéktalanul eltávolítható-e ezzel a módszerrel. INTRODUCTION: Surgical technique of thymectomy performed for treatment of myasthenia gravis has considerably changed in the last almost 30 years. In addition to standard interventions - transsternal and transcervical thymectomy -, video-assisted thoracoscopic interventions (VATS), later on robotic surgery came into general use. In our two institutions, we apply VATS thymectomy since 2011. METHODS: There are several different surgical techniques for this purpose; we approached the mediastinum through the right thoracic cavity. We prepared initially 3, later on 2 perimammal ports for the access of the thymus; the patients were in supine position during surgery. We used an ultrasonic cutting device in all cases. In order to perform extended thymectomy, we removed the fatty tissue around the thymus and opened widely the left thoracic cavity, too. During patient enrollment, we preferred patients with normal or lower body weight. RESULTS: During 8 years and 4 months, we operated on 92 patients using this method for myasthenia gravis without thymoma; there were 20 male and 72 female patients at the age of 33 years on average (19-75 years). Duration of surgery was 35-160 minutes, 82.3 minutes on average. The bulky fatty tissue around the thymus made the orientation and the complete removal more difficult in a few patients. We experienced vascular injury in 4 cases and injury of the contralateral lung in 3 cases. Conversion was necessary in 2 cases (1 sternotomy and 1 thoracotomy), there were no nerve injuries. Assisted ventilation was necessary in case of ten patients in the postoperative period for a few hours; all other patients were extubated on the operating table. There was no need for repeated intubation and tracheostomy; there was no respiratory insufficiency and perioperative mortality. Duration of ICU care was 1.1 days on the average (0-11 days), that of the total hospital care 4.8 days on average (3-15 days). Duration of thoracic drainage was 1.16 days on average (1-4 days). Two patients (2.41%) died within one and five years after surgery. During 12-108 months (48 months on average) follow-up of 81 patients, 21 patients (25.3%) suffering from myasthenia total recovery was observed, pharmacologic remission was achieved in 4 patients (5.3%), minimal manifestation remained in 23 patients (24.1%), while in 28 patients (33.73%) other improvement was observed. The status of 4 patients (4.82%) remained unchanged and that of 4 patients (5.3%) worsened. CONCLUSION: VATS thymectomy represents a completely new surgical method for surgeons having experience in transsternal surgical technique. Bulky mediastinal fatty tissue makes surgery very difficult. The perioperative period is advantageous for the patients and also the long term follow-up results are acceptable. It is questionable that the thymus can be completely removed with this method in all cases.


Assuntos
Miastenia Gravis/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370965

RESUMO

Tracheal tear after endotracheal intubation is extremely rare. The role of silicone Y-stent in the management of tracheal injury has been documented in the previous studies. However, none of the studies have mentioned the deployment of silicone Y-stent via rigid bronchoscope with the patient solely supported by extracorporeal membrane oxygenation (ECMO) without general anaesthesia delivered via the side port of the rigid bronchoscope. We report a patient who had a tracheal tear due to endotracheal tube migration following a routine video-assisted thoracoscopic surgery sympathectomy, which was successfully managed with silicone Y-stent insertion. Procedure was done while she was undergoing ECMO; hence, no ventilator connection to the side port of the rigid scope was required. This was our first experience in performing Y-stent insertion fully under ECMO, and the patient had a successful recovery.


Assuntos
Oxigenação por Membrana Extracorpórea , Complicações Intraoperatórias/terapia , Intubação Intratraqueal/efeitos adversos , Lacerações/terapia , Traqueia/lesões , Broncoscopia , Falha de Equipamento , Feminino , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Intubação Intratraqueal/instrumentação , Lacerações/diagnóstico , Lacerações/etiologia , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Ventilação Monopulmonar/instrumentação , Stents , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Traqueia/diagnóstico por imagem , Adulto Jovem
9.
Rev. cuba. cir ; 59(4): e1009, oct.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1149845

RESUMO

RESUMEN Introducción: La enfermedad pulmonar intersticial difusa constituye un grupo heterogéneo de lesiones con varias características comunes entre las cuales resaltan la inflamación y cicatrización del órgano. Por lo general, se requiere la obtención de tejido parenquimatoso para el diagnóstico definitivo. Objetivos: Describir los resultados obtenidos, según el método de minitoracotomía o cirugía torácica videoasistida, para obtener las muestras hísticas para estudio histopatológico. Métodos: Se realizó un estudio observacional, longitudinal y prospectivo de 52 pacientes consecutivos, con diagnóstico de enfermedad pulmonar intersticial difusa, a quienes se les practicó la toma de muestras tisulares obtenidas mediante cirugía torácica videoasistida o minitoracotomía en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" entre el 2001 y el 2018. Se estudió la edad y el sexo de los pacientes, la técnica quirúrgica empleada y las complicaciones y mortalidad. Los resultados se exponen en tablas, en números absolutos y relativos. Resultados: Predominó el sexo femenino (59,6 por ciento). La técnica quirúrgica más utilizada fue la minitoracotomía (75,0 por ciento) en pacientes entre 41-50 años, con 15 enfermos. La afección más frecuente fue la fibrosis pulmonar con un 78,8 por ciento. En dos enfermos intervenidos mediante cirugía torácica videoasistida no fue posible obtener tejido para biopsia (15,4 por ciento). Hubo dos complicaciones en pacientes operados mediante minitoracotomía. Conclusiones: La cirugía torácica videoasistida permite una amplia exploración de la superficie pulmonar, pero la biopsia abierta puede tener la misma efectividad para la obtención de muestras hísticas pulmonares, con un mínimo por ciento de complicaciones y bajo índice de mortalidad(AU)


ABSTRACT Introduction: Diffuse interstitial lung disease makes up a heterogeneous group of lesions with several common characteristics, among which inflammation and scarring of the organ stand out. Generally, obtaining parenchymal tissue is required for definitive diagnosis. Objectives: To describe the outcomes of using the method of minithoracotomy or video-assisted thoracic surgery to obtain tissue samples for histopathological study. Methods: An observational, longitudinal and prospective study was carried out with 52 consecutive patients with a diagnosis of diffuse interstitial lung disease. Tissue samples obtained by video-assisted thoracic surgery or mini-thoracotomy were taken at Hermanos Ameijeiras Clinical-Surgical Hospital, between 2001 and 2018. The age and sex of the patients, the surgical technique used, and complications and mortality were studied. The results are presented in tables, in absolute and relative numbers. Results: The female sex predominated (59.6 percent). The most widely used surgical technique was minithoracotomy (75.0 percent) in patients between 41-50 years (15 patients). The most frequent condition was pulmonary fibrosis, accounting for 78.8 percent. In two patients who underwent video-assisted thoracic surgery, it was not possible to obtain any tissue for biopsy (15.4 percent). There were two complications in patients operated on by minithoracotomy. Conclusions: Video-assisted thoracic surgery allows wide exploration of the lung surface, but open biopsy can be just as effective in obtaining lung tissue samples, with a minimum percentage of complications and a low mortality rate(AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Toracotomia/métodos , Doenças Pulmonares Intersticiais/patologia , Cirurgia Torácica Vídeoassistida/métodos , Estudos Prospectivos , Estudos Longitudinais , Estudos Observacionais como Assunto
10.
Medicine (Baltimore) ; 99(40): e22574, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019470

RESUMO

RATIONALE: Pulmonary sequestration (PS) presenting with elevated serum tumor markers is rare, and it might be misdiagnosed as malignancy. PATIENT CONCERNS: A 26-year-old asymptomatic male patient was admitted because the x-ray showed an intrathoracic lesion. Meanwhile, the serum neuron-specific enolase (NSE) was elevated. Three-dimensional computed tomography angiography revealed an isolated feeding vessel arising from the aorta. DIAGNOSES: Extralobular PS was confirmed by computed tomography angiography and postoperative pathological staining. INTERVENTIONS: Two-port thoracoscopic resection of the sequestrated lobe was performed. OUTCOMES: The serum NSE decreased to within the normal range and persisted during the follow up of 10 months. LESSONS: A thorough work-up should be considered for the PS patients presenting with abnormal serum NSE. Detailed knowledge regarding the relationship between NSE and PS necessitates further studies.


Assuntos
Sequestro Broncopulmonar/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Fosfopiruvato Hidratase/sangue , Adulto , Assistência ao Convalescente , Aorta/anormalidades , Aorta/diagnóstico por imagem , Sequestro Broncopulmonar/patologia , Sequestro Broncopulmonar/cirurgia , Humanos , Masculino , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
11.
Pneumologie ; 74(10): 684-694, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-33059374

RESUMO

The contingent of VATS (video assistend thoracic surgery) lobectomies will continue to increase in the time to come. Thoracic surgery departments that do not integrate this procedure into their routine spectrum will have to justify themselves to referrers and clinic administrations and will have problems with the recruitment of training assistants as well. The advantages of minimally invasive lobectomy are impressive and the long-term oncological results are equivalent to open lobectomy. VATS lobectomies in non-intubated patients will increase significantly in the next few years and further reduce the invasiveness of the operation. The number of clinics that offer RATS (roboter assistend thoracic surgery) lobectomies will also increase as more companies bring robot systems onto the market, making them significantly cheaper. Better screening programs for risk patients for lung cancer, rapid advances in thoracic oncology and further minimization of surgical trauma in lung resections will significantly improve the overall therapy and prognosis for lung cancer patients in the years to come.


Assuntos
Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Humanos , Neoplasias Pulmonares/patologia , Pneumonectomia/efeitos adversos , Prognóstico , Cirurgia Torácica , Cirurgia Torácica Vídeoassistida/efeitos adversos , Resultado do Tratamento
12.
Rev. cuba. cir ; 59(3): e975, jul.-set. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144432

RESUMO

RESUMEN Introducción: Los teratomas se definen como tumores de tejidos extraños al órgano o sitio anatómico en el cual se originan. Los teratomas mediastinales no son frecuentes, representan alrededor del 5 por ciento al 10 por ciento de todos los tumores mediastinales. Objetivo: Describir los resultados del tratamiento quirúrgico de pacientes con diagnóstico de teratomas mediastinales. Métodos: Se estudiaron 12 pacientes tratados entre enero de 2001 y diciembre de 2018. Las variables evaluadas fueron sexo, edad, tipo histológico: maduro o inmaduro, vía de acceso quirúrgico, accidentes quirúrgicos y evolución postoperatoria. Resultados: Correspondieron 9 al sexo femenino y 3 al masculino. El promedio de edad fue de 33,3 años (17-60 años). Hubo predominio absoluto del tipo maduro (11). La esternotomía media fue el acceso más frecuente. La toracotomía se realizó cuando el tumor, voluminoso, ocupaba la mayor parte de un hemitórax. Los accidentes quirúrgicos fueron un desgarro pulmonar y una apertura del pericardio. De dos pacientes tratados mediante cirugía torácica videoasistida, uno fue convertido por sangrado venoso molesto. Al año de seguimiento todos estaban vivos, sin evidencias de recidiva. Conclusiones: Contrariamente a lo esperado, hay predominio del sexo femenino, mientras que la edad y el tipo histológico coinciden con la literatura. La esternotomía, aún hoy, es comúnmente aceptada, a pesar del auge de la cirugía torácica videoasistida. La resección total produce resultados excelentes para los teratomas benignos(AU)


ABSTRACT Introduction: Teratomas are defined as tumors of tissues foreign to the organ or anatomical site in which they originate. Mediastinal teratomas are rare, accounting for about 5-10 percent of all mediastinal tumors. Objective: To describe the outcomes of the surgical treatment of patients diagnosed with mediastinal teratomas. Methods: Twelve patients treated between January 2001 and December 2018 were studied. The variables evaluated were sex, age, histological type (mature or immature), surgical access route, surgical accidents, and postoperative evolution. Results: Nine patients corresponded to the female sex and three, to the male. The average age was 33.3 years (17-60 years). There was an absolute predominance of the mature type (11). Median sternotomy was the most frequent access. Thoracotomy was performed when the bulky tumor occupied most of a hemithorax. The surgical accidents were lung tear and opening of the pericardium. Of two patients treated by video-assisted thoracic surgery, one was converted for bothersome venous bleeding. At one year of follow-up, all were alive, with no evidence of recurrence. Conclusions: Contrary to expectations, there is predominance of the female sex, while age and histological type coincide with the literature. Sternotomy, even today, is commonly accepted, despite the rise of video-assisted thoracic surgery. Total resection produces excellent outcomes in benign teratomas(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Teratoma/diagnóstico , Toracotomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Esternotomia/métodos , Estudos Retrospectivos
13.
Eur J Cardiothorac Surg ; 58(3): 598-604, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32856063

RESUMO

OBJECTIVES: There is currently a lack of clinical data on the novel beta-coronavirus infection [caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] and concomitant primary lung cancer. Our goal was to report our experiences with 5 patients treated for lung cancer while infected with SARS-CoV-2. METHODS: We retrospectively evaluated 5 adult patients infected with SARS-CoV-2 who were admitted to our thoracic surgery unit between 29 January 2020 and 4 March 2020 for surgical treatment of a primary lung cancer. Clinical data and outcomes are reported. RESULTS: All patients were men with a mean age of 74.0 years (range 67-80). Four of the 5 patients (80%) reported chronic comorbidities. Surgery comprised minimally invasive lobectomy (2 patients) and segmentectomy (1 patient), lobectomy with en bloc chest wall resection (1 patient) and pneumonectomy (1 patient). Mean chest drain duration was 12.4 days (range 8-22); mean hospital stay was 33.8 days (range 21-60). SARS-CoV-2-related symptoms were fever (3 patients), persistent cough (3 patients), diarrhoea (2 patients) and syncope (2 patients); 1 patient reported no symptoms. Morbidity related to surgery was 60%; 30-day mortality was 40%. Two patients (1 with a right pneumonectomy, 74 years old; 1 with a lobectomy with chest wall resection and reconstruction, 70 years old), developed SARS-CoV-2-related lung failure leading to death 60 and 32 days after surgery, respectively. CONCLUSIONS: Lung cancer surgery may represent a high-risk factor for developing a severe case of coronavirus disease 2019, particularly in patients with advanced stages of lung cancer. Additional strategies are needed to reduce the risk of morbidity and mortality from SARS-CoV-2 infection during treatment for lung cancer.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Infecções por Coronavirus/diagnóstico , Infecção Hospitalar/prevenção & controle , Neoplasias Pulmonares/cirurgia , Pneumonia Viral/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Itália , Tempo de Internação , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pandemias , Pneumonectomia/métodos , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Estudos Retrospectivos , Amostragem , Síndrome Respiratória Aguda Grave/complicações , Síndrome Respiratória Aguda Grave/mortalidade , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(34): e21737, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846795

RESUMO

RATIONALE: One-lung ventilation (OLV) is essential for adequate visualization and exposure of the surgical site via a videoscopic approach. Although many instruments facilitating OLV are available, the choice is limited in pediatric patients. PATIENT CONCERNS: A 4-year-old female (weight: 18.6 kg, height: 100 cm) was admitted via our pediatric outpatient clinic because of recurrent hemoptysis, 2 weeks in duration. She had no medical or surgical history. DIAGNOSIS: Contrast-enhanced computed tomography (CT) revealed a 4.5-cm-diameter mass in the left, lower lung lobe. She was diagnosed with a congenital pulmonary airway malformation (CPAM). INTERVENTIONS: She was scheduled for emergency lobectomy via video-assisted thoracoscopic surgery (VATS). To ensure successful VATS, OLV was essential. As our hospital lacked a small-diameter fiberoptic bronchoscope and a proper bronchial blocker, we decided to use single-lumen tube (SLT) with adult fiberoptic bronchoscope. OUTCOMES: We performed successful bronchoscopic-guided OLV using a SLT. We aligned the tube to the right upper lobar bronchus and Murphy eye to prevent obstruction of the right upper lobe bronchus. At the end of surgery, the endotracheal tube lumen had been narrowed by blood clots, we decided to exchange the tracheal tube. The tube was immediately exchanged. After re-intubation, the pulse oximetry (SpO2) then gradually increased. LESSONS: Appropriate preparation and careful management should be considered to perform OLV in pediatric patients without significant complications.


Assuntos
Broncoscopia/métodos , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Ventilação Monopulmonar/métodos , Cirurgia Torácica Vídeoassistida/métodos , Broncoscopia/instrumentação , Pré-Escolar , Feminino , Humanos
16.
Medicine (Baltimore) ; 99(27): e20964, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629705

RESUMO

Intraoperative radiotherapy (IORT) has been used to treat different residual solid tumors after tumor removal and has shown many advantages over other treatment methods. However, the use of IORT for invasive thymoma has not been reported. Therefore, in this study, we tried to determine the safety and efficacy of INTRABEAM IORT for the treatment of invasive thymoma.Among the patients admitted to our hospital from September to December 2016 who were diagnosed with invasive thymoma, 14 were selected as study subjects. With medical histories taken beforehand, 8 of these patients were diagnosed with Masaoka stage IIA and 6 with Masaoka stage IIB; furthermore, 5 of the patients were diagnosed with myasthenia gravis (MG). INTRABEAM radiation (8-10 Gy, low energy) was delivered to the postoperative tumor bed of each patient during surgery. The intra- and postoperative complications were observed and evaluated, and the improvement in symptoms was assessed. An additional 23 patients with stage II thymoma undergoing radical surgery from April to August 2016 were chosen as the control group.One month after the operation, only 1 patient in the IORT group had cough, increased levels of leucocytes and neutrophils, and pulmonary inflammation on chest computed tomography. Reactive inflammation and pleural effusion in the 2 groups were similar (P > .05). There was no significant difference between the 2 groups in the improvement of myasthenia gravis (P > .05). Postoperative chest computed tomography and routine blood examination at 3 and 12 months showed that all the patients recovered, with normal hemogram levels and no pulmonary fibrosis around the radiation field. In addition, ultrasonic cardiography and electrocardiography demonstrated no significant difference before or after surgery within the IORT group. At the end of the follow-up, all the patients were alive, no relapse or remote metastasis was observed in the IORT group, and 2 inpatients in the control group had experienced relapse at 24 and 26 months. There was a significant difference in disease-free survival between the 2 groups (P = .00).It is safe to administer low-energy INTRABEAM IORT at a dose of approximately 10 Gy in patients with stage II invasive thymoma. INTRABEAM IORT does not significantly increase operation- or radiation-related complications and has no significant effect on vital organs such as the lungs and heart. Its long-term efficacy is worth expecting.


Assuntos
Timoma/radioterapia , Neoplasias do Timo/radioterapia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/complicações , Dosagem Radioterapêutica , Radioterapia Adjuvante/instrumentação , Radioterapia Adjuvante/métodos , Cirurgia Torácica Vídeoassistida/métodos , Timoma/complicações , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia
18.
Artigo em Inglês | MEDLINE | ID: mdl-32633902

RESUMO

Malignant pleural mesothelioma is a disease of the pleural cavity that is strongly associated with asbestos exposure. In most cases it carries a poor prognosis. Patients often present with respiratory symptoms, caused by pleural effusion. Treatment, preferably in a multimodal setting, cannot provide cure, but can prolong survival and improve quality of life in selected cases.  Prior to eventual cytoreductive surgery, surgical intervention can provide histopathological proof of disease, and symptoms can be controlled with talc pleurodesis.  We present the case of a 67-year-old patient with malignant pleural mesothelioma who underwent video-assisted thoracoscopic biopsy and talc pleurodesis, and demonstrate our technique with a video tutorial showing how we performed the procedure.


Assuntos
Biópsia Guiada por Imagem/métodos , Neoplasias Pulmonares , Mesotelioma , Pleurodese/métodos , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/terapia , Masculino , Mesotelioma/patologia , Mesotelioma/fisiopatologia , Mesotelioma/terapia , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/prevenção & controle
19.
Artigo em Inglês | MEDLINE | ID: mdl-32633903

RESUMO

Video-assisted thoracic surgery (VATS) lobectomy is the gold standard for the treatment of early-stage lung cancer. The use of surgical models for training and simulation in minimally invasive surgery simulation is an integral part of surgical education and skills acquisition for residents, and also for more experienced surgeons.Live animals  are still the most frequently used realistic surgical models.  In this video tutorial, we demonstrate the use of a new human cadaver model with the aim of replacing the live animal model without compromising the fidelity of the simulation.  To prepare the cadaver, selective cannulation of the heart was performed to fill the pulmonary vessels with a gel used to improve the visibility and tactile feed-back of the vessels, and to simulate any bleeding complications. The complete cadaver was then used for the simulation, with all the same instruments and devices required in normal clinical practice, to demonstrate and practice both surgical and non-surgical skills for VATS lobectomy. In our opinion this model provides most of the features necessary for a valid surgical simulator and allows realistic training for VATS lobectomy. We believe that the cadaver model can be an effective alternative to anesthetized animals for VATS lobectomy training and simulation.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Cadáver , Humanos , Modelos Anatômicos , Treinamento por Simulação/métodos
20.
Artigo em Inglês | MEDLINE | ID: mdl-32633904

RESUMO

Isolated endobronchial tumors of the left main bronchus are quite rare. They are treated by surgical resection, preferably using lung-sparing techniques, when possible. These procedures are technically challenging and are usually performed through a standard thoracotomy.  This video tutorial shows a left main bronchus sleeve resection with distal lobar carina reconstruction, performed through a uniportal thoracoscopic approach, for a typical carcinoid tumor of the distal left main bronchus.


Assuntos
Neoplasias Brônquicas , Tumor Carcinoide , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Brônquios/patologia , Brônquios/cirurgia , Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Humanos , Masculino , Tratamentos com Preservação do Órgão/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Resultado do Tratamento
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