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1.
Einstein (Sao Paulo) ; 18: eAO4409, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31618286

RESUMO

OBJECTIVE: To compare the chest tube drainage by the same thoracotomy intercostal space with the traditional approach in patients undergoing muscle-sparing thoracotomy. METHODS: We evaluated 40 patients aged ≥18 years who underwent elective muscle sparing thoracotomies. Patients were divided into two groups of 20 patients. One group underwent thoracic drainage by the same intercostal space of thoracotomy and the other by traditional chest drainage approach. RESULTS: The mean length of hospital stay for the intercostal drainage group in the intensive care unit was 1.5 day (1.0 to 2.0 days) and 2.0 days (25.1 to 3.0 days) for the traditional chest drainage group (p=0.060). The intercostal drainage group had mean length of hospital stay (p=0.527) and drainage (p=0.547) of 4 days, and the traditional chest drainage group and 2 and 5.5 days, respectively. Dipirona and tramadol doses did not differ between groups (p=0.201 and p=0.341). The mean pain scale values on first postoperative was 4.24 in the drainage by the same intercostal group and 3.95 in the traditional chest drainage (p=0.733). In third postoperative day, mean was 3.18 for the first group and 3.11 for the traditional group (p=0.937). In the 15th day after surgery, drainage by the incision was 1.53 and the traditional chest drainage was 2.11 (p=0.440), 30th days after drainage by incision was 0.71 and traditional chest drainage was 0.84 (p=0.787). Complications, for both groups were similar with 30% in proposed drainage and 25% in traditional approach (p=0.723). CONCLUSION: Drainage by the same thoracotomy intercostal space was feasible and results 30 days after surgery were not inferior to those of the traditional chest drainage approach.


Assuntos
Tubos Torácicos , Drenagem/métodos , Toracotomia/métodos , Analgesia Epidural , Analgésicos/uso terapêutico , Fibrilação Atrial/etiologia , Dipirona/uso terapêutico , Drenagem/estatística & dados numéricos , Dispneia/etiologia , Humanos , Tempo de Internação , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Período Pós-Operatório , Estudos Prospectivos , Toracotomia/efeitos adversos , Tramadol/uso terapêutico
6.
Pan Afr Med J ; 33: 164, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31565126

RESUMO

Schwannoma is a neurogenic tumor originating from Schwann cells. When considering the thoracic region, it is most commonly found in the mediastinum. It commonly appears as a solitary lesion and pleural involvement is extremely rare. We here report the case of a 44-year old woman with benign primitive schwannoma of the pleura whose lesion was detected after radiological assessment for chest pain and dyspnea. The patient underwent complete surgical resection using video-assisted thoracoscopic surgery (VATS) technique. The anatomopathological study showed benign primitive schwannoma of the pleura.


Assuntos
Neurilemoma/diagnóstico , Neoplasias Pleurais/diagnóstico , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Dor no Peito/etiologia , Dispneia/etiologia , Feminino , Humanos , Neurilemoma/patologia , Neurilemoma/cirurgia , Neoplasias Pleurais/patologia , Neoplasias Pleurais/cirurgia
7.
Medicine (Baltimore) ; 98(39): e17345, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574876

RESUMO

RATIONAL: Laryngeal granulomas are benign lesion that rarely occurs after surgery of laryngeal cancer. Until now there has not been standard treatment for it. PATIENT CONCERN: The patient was diagnosed with laryngeal neoplasm one and half a month ago. Endoscopic low-temperature plasma knife in the radical excision of left vocal cord was performed under the general anesthesia. Postoperative histopathological examination confirmed left vocal cord tumor was highly differentiated invasive squamous cell carcinoma (SCC). Then the patient suffered unexplained intermittent dyspnea which persisted nearly 1 month after the surgery. Laryngoscope examination showed granulation formation on the glottis. DIAGNOSES: The patient was diagnosed with laryngeal granuloma 1 month after the surgery of laryngeal cancer. INTERVENTIONS: The patient received resection of the laryngeal mass, and pathological examination confirmed the granuloma. Postoperative radiotherapy (RT) was performed within 24 hours after surgery. OUTCOMES: The patient was followed up for 3 years after surgery and the laryngeal granuloma and laryngeal cancer did not recur during follow-up. The symptoms of intermittent dyspnea disappeared and a satisfactory outcome was achieved. LESSONS: Usually for primary laryngeal granulomas, surgical treatment alone is not enough, because it is easy to relapse. RT within 24 hours after operation can significantly reduce the recurrence of laryngeal granuloma.


Assuntos
Carcinoma de Células Escamosas/terapia , Granuloma Laríngeo/etiologia , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Dispneia/etiologia , Feminino , Humanos
11.
Praxis (Bern 1994) ; 108(11): 741-749, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480954

RESUMO

CME: Nocturnal Dyspnea Abstract. Nocturnal dyspnea has a broad range of differential diagnoses of sometimes serious and even life-threatening illnesses. Systematic assessment starts with taking a detailed medical history to characterize the dyspnea and evaluate possible underlying diseases. The subsequent clinical and complementary evaluation should be targeted to detect possible diseases of the upper and lower respiratory tract, the lungs, disorders of control of breathing, heart diseases as well as neurological and, after exclusion of other causes, mental illnesses.


Assuntos
Dispneia , Cardiopatias , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Cardiopatias/complicações , Cardiopatias/diagnóstico , Humanos
14.
Medicine (Baltimore) ; 98(31): e16640, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374034

RESUMO

RATIONALE: Tumors in the heart are rare. Myxomas, rhabdomyomas, and fibromas are the most common benign cardiac tumors. Hamartoma of mature cardiomyocytes (HMCM) is another benign cardiac tumor, are very rare and have only been reported in a few literatures. PATIENT CONCERNS: We report a case of 41-year-old male who suffered short of breath for 3 years, and lower limbs edema for 2 years. DIAGNOSES: Transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) showed a large amount of pericardial effusion and confirmed a mass of 18 × 14 mm on the superior vena cava near the outer edge of right atrium. The patient was first diagnosed as pleural mesothelioma. Surgery was performed to relieve the symptoms and confirm diagnoses. However, during surgery, we found the right atrium is apparently thicken with rough and uneven surface. Histology of right atrium mass indicated it as hamartoma of mature cardiomyocytes. INTERVENTION: We resected the thicken atrial wall completely, reconstructed right atrium with bovine pericardial patch, and resected the pericardium. OUTCOMES: Patient was discharged 9 days after surgery, and remained asymptomatic during 9 months follow up. LESSONS: Hamartoma of mature cardomyocytes is a rare benign cardiac tumor. There were 26 cases reported until now. The conclusive diagnosis depends on pathological sections. For patients with symptoms, surgery is an effective treatment for HMCM.


Assuntos
Hamartoma/patologia , Átrios do Coração/patologia , Cardiopatias/patologia , Miócitos Cardíacos/patologia , Adulto , Dispneia/etiologia , Ecocardiografia , Edema/etiologia , Hamartoma/complicações , Hamartoma/cirurgia , Cardiopatias/complicações , Cardiopatias/cirurgia , Humanos , Masculino
15.
Medicine (Baltimore) ; 98(32): e16732, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393382

RESUMO

Medical decisions should be well-planned to improve prognosis and reduce complications of mediastinal tumors. In this study, we analyzed the clinical presentations of pediatric mediastinal tumors and their correlation with long-term clinical outcome.Forty patients under 18 years of age diagnosed with mediastinal tumors at China Medical University Children's Hospital between 2001 and 2016 were enrolled. The patients' sex, age of onset, initial clinical symptoms, and treatment outcomes were analyzed.75% of the patients with mediastinal tumors in this study were men, and the median age of onset was 13 years old (age range: 0-17 years). The overall mortality rate was 40%. The most common tumors were lymphoma (47.5%), followed by germ cell tumors (12.5%), neuroblastoma (12.5%), and thymoma (7.5%). Neuroblastoma was more prevalent in girls younger than 5 years old. The initial presentations of these patients included breathing difficulty (65%), productive cough (47.5%), pleural effusion (54.5%), superior vena cava (SVC) syndrome (35%), neck mass (35%), airway compression (32.5%), fever (30%), chest pain (27.5%), and pericardial effusion (25%). Lymphomas were more likely to be accompanied by neck mass (52.6% vs19.0%, P = .04) and SVC syndrome (52.6% vs 19.0%, P = .026), yet also had a better 1-year-survival rate (68.4% vs 52.4%, P = .02).Overall, lymphoma should be suspected when children present with neck mass and SVC syndrome. Neuroblastoma with a posterior mediastinal origin should be suspected among children younger than 5 years old. Tumor-related airway obstruction, pleural effusion, and pericardial effusion were leading cause of cardiopulmonary instability during sedation for invasive procedures, which should be managed cautiously.


Assuntos
Neoplasias do Mediastino/epidemiologia , Neoplasias do Mediastino/patologia , Adolescente , Idade de Início , Criança , Pré-Escolar , Dispneia/etiologia , Feminino , Humanos , Lactente , Masculino , Neoplasias do Mediastino/complicações , Derrame Pleural/etiologia , Fatores Sexuais , Síndrome da Veia Cava Superior/etiologia
16.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 189-192, 2019 08 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31465189

RESUMO

Chronic graft versus host disease (GVHD) is a major complication of the allogeneic stem cell transplant. One of most frequent manifestations of GVHD is the cutaneous compromise with the sclerodermatous variety being the most severe. We considered that the restrictive respiratory compromise and its evolution are not well characterized. We described the functional respiratory alterations of a patient with sclerodermatous chronic GVHD and considered differential diagnosis of pulmonary restriction in this type of patient. We reported the case of a 21-year-old woman with pulmonary restriction secondary to cutaneous sclerosis which was caused by chronic GVHD. This report illustrates the importance of utilizing both functional respiratory tests and diagnosis images to accurately characterize the cause of the respiratory compromise. We believe that the functional alterations described in this case could be caused by the cutaneous disorder found.


Assuntos
Dispneia/etiologia , Doença Enxerto-Hospedeiro/complicações , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Escleroderma Sistêmico/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Leucemia Mieloide Aguda/cirurgia
17.
Pan Afr Med J ; 33: 39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384354

RESUMO

Hageman factor (factor XII) has a key role in activation of intrinsic coagulation system gauged by activated partial thromboplastin time (aPPT). Hageman factor deficiency is more often an autosomal recessive condition, but an autosomal dominant inheritance is also reported. This condition in its own is not known to cause bleeding complications rather is associated with paradoxical fatal thromboembolic complications. Exact prevalence of this condition is not known, as under normal conditions they are asymptomatic. In literature, a prevalence of 2.3% has been reported in one study on 300 patients presenting with complications. Homozygous patients has non-detectable levels of factor XII, while heterozygous individuals has variable levels ranging from 20-60%. Hageman factor is a pro-coagulation protein initiating intrinsic pathway. Intrinsic pathway is activated either by direct contact with a negative charged surface or by proteolytic activation on the endothelial cells via prekallikerin/kallikerin system. Factor XII as an integral part of this system leads to factor XI activation resulting in production of thrombin orchestrated by intrinsic system. In addition, there is concomitant activation of complement components C3 and C5 via C1-estrase activation. Patients with this condition are known to have spontaneous thromboembolic complications although less common but are prone to life threatening complications under provocating circumstances. The aim of this case report is to study the relation of factor XII deficiency and isolated raised activated partial thromboplastin time (aPPT) and how it can be prevented. We are presenting a Saudi female patient, 29 years of age who presented to accident and emergency room (A&E room) of our hospital with sudden severe breathlessness and chest pain.


Assuntos
Deficiência do Fator XII/diagnóstico , Fator XII/análise , Tempo de Tromboplastina Parcial , Adulto , Dor no Peito/etiologia , Dispneia/etiologia , Serviço Hospitalar de Emergência , Deficiência do Fator XII/complicações , Feminino , Humanos
19.
Pan Afr Med J ; 33: 11, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303956

RESUMO

Pseudo-Meigs syndrome combines a benign (all histological types are included) or malignant (primitive ovarian tumor or ovarian metastasis from another primitive tumor) ovarian tumor or a pelvic tumor (not necessarily ovarian or uterine, for example) with ascites and pleurisy (non-metastatic in the case of malignant tumor). These effusions disappear after tumor resection. A 37-year old female patient was admitted to our Department with dyspnoea and left intercostal pain. Radiological examinations showed left pleurisy of average abundance, ascites of low abundance and a pelvic mass. Surgical exploration showed ovarian tumor. After ablation, pleurisy solved spontaneously. Of particular interest, with regard to pneumology, is that this syndrome has occurred in a woman with pleurisy whose etiological assessment was negative and that abdominopelvic ultrasound allows diagnostic orientation.


Assuntos
Cistadenoma Seroso/diagnóstico , Síndrome de Meigs/etiologia , Neoplasias Ovarianas/diagnóstico , Adulto , Ascite/etiologia , Cistadenoma Seroso/complicações , Cistadenoma Seroso/patologia , Dispneia/etiologia , Feminino , Humanos , Síndrome de Meigs/patologia , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/patologia , Dor/etiologia , Pleurisia/etiologia
20.
Medicine (Baltimore) ; 98(28): e16389, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305444

RESUMO

INTRODUCTION: Various phenotypes have been identified for MYH7 gene mutation-related myopathy. Here, we describe a patient with severe muscular weakness and skeletal deformity with de novo heterozygous MYH7 gene mutation. PATIENT CONCERNS: A 33-year-old woman presented with early onset of muscular weakness, with delayed motor development during infancy. At age 8 years, she was unable to walk, with signs of skeletal deformity, including the progression of kyphoscoliosis. At age 31 years, she developed dyspnea. DIAGNOSIS: She diagnosed with esophageal hiatal hernia with abdominal CT. In electromyography, short duration, small amplitude motor unit action potential (MUAP), and early recruitment patterns were observed in the involved proximal muscles, suggesting myopathy. Muscle histopathology showed fiber-type disproportion. INTERVENTIONS: Next-generation sequencing study revealed a heterozygous in-frame deletion variation in the exon 14 of the MYH7 gene (c.1498_1500del/p.Glu500del), which is a novel variation confirmed by conventional Sanger sequencing. Compared with the parental test, this variant was concluded as de novo. OUTCOMES: She received laparoscopic hiatal hernia repair and Nissen fundoplication for esophageal hiatal hernia. After surgery, her postural dyspnea improved. As there is no fundamental treatment for MYH7-related myopathies, she continued conservative treatment for her symptoms. CONCLUSION: Here, we presented a rare case of de novo mutation of the myosin head domain in the MYH7 gene. This report broadens both the phenotypic and genotypic spectra of MYH7-related myopathies.


Assuntos
Miosinas Cardíacas/genética , Cifose/genética , Debilidade Muscular/genética , Mutação , Cadeias Pesadas de Miosina/genética , Escoliose/genética , Adulto , Idade de Início , Dispneia/etiologia , Dispneia/genética , Dispneia/cirurgia , Feminino , Humanos , Cifose/fisiopatologia , Debilidade Muscular/patologia , Debilidade Muscular/fisiopatologia , Fenótipo , Escoliose/fisiopatologia
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