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1.
Hinyokika Kiyo ; 67(2): 73-77, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33657775

RESUMO

The patient was a 69-year-old man with localized cT1cN0M0 prostate cancer, who underwent robotassisted laparoscopic prostatectomy (RALP). The operation time was 188 minutes, blood loss was 300 ml, including urine, and no intraoperative complications were noted. The fourth day after RALP, he suddenly complained of nausea and vomiting, and there was right lateral abdominal tenderness. Emergency abdominal computed tomographic scan revealed small intestinal hernia in the right lower abdomen, and we performed emergency laparoscopic surjery. At re-operation, we found lacerations of the peritoneum and transversus abdominis fascia at the insertion site of the 12 mm assistant port, and prolapse of the small intestine. Our diagnosis was lateral port site hernia following RALP. There was no necrosis in the small intestine. The transversus abdominis fascia was Z-sutured through the abdominal cavity with an absorbable thread, and the oblique abdominis muscle was Z-sutured extracorporeally to complete the operation. The patient was discharged on the eleventh day with good progress after re-operation. The possibility of lateral port-site hernia after RALP should be kept in mind, and more reliable port-site closure should be considered.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Idoso , Hérnia/diagnóstico por imagem , Hérnia/etiologia , Humanos , Masculino , Prostatectomia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
2.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431531

RESUMO

Angiofibroma is a benign soft tissue tumour presenting as a gradually progressive swelling in the vulvovaginal area in women and in the inguinoscrotal region in men. Being a rare tumour, there are only a few case reports in the literature, and among them, presentation as perineal herniation is very rare. En bloc resection of angiofibroma either via laparoscopic or open approach is the choice of treatment to avoid recurrence. Detailed pathological examination and immunohistochemistry workup are imperative to distinguish it from various mesenchymal tumours. Perineal hernia is itself rare and may occur spontaneously or following abdominoperineal resection, sacrectomy or pelvic exenteration. Surgical repair via open transabdominal and transperineal approaches has been described. Here, we report a case of a young woman who presented with spontaneous reducible perineal hernia with a soft tissue tumour as its content, which on histopathological investigation was found to be an angiofibroma.


Assuntos
Angiofibroma/diagnóstico , Hérnia/etiologia , Herniorrafia/métodos , Períneo/patologia , Neoplasias de Tecidos Moles/diagnóstico , Adulto , Angiofibroma/complicações , Angiofibroma/patologia , Angiofibroma/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Posicionamento do Paciente/métodos , Períneo/diagnóstico por imagem , Períneo/cirurgia , Neoplasias de Tecidos Moles/complicações , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia
4.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334746

RESUMO

A 28-year-old man presented with a progressive inward deviation of the left eye in the last 4 years. Examination revealed -3 abduction and elevation deficit in the left eye with 50 prism diopters (PD) esotropia and 12 PD of hypotropia. The patient had multiple fibromas on the forearms with pulsatile globe and was diagnosed as neurofibromatosis type 1. Myopic strabismus fixus was suspected. MRI revealed left temporal lobe herniation through a dysplastic sphenoid wing, compressing the posterior half of the superior rectus and lateral rectus muscles, resulting in an esotropia-hypotropia complex. Surgical treatment involved suture myopexy (Yokoyama's technique) of the left superior rectus and lateral rectus muscles with a 6.5 mm left medial rectus recession. Two months postoperatively, the patient had minimal residual esotropia and hypotropia. MRI orbits should always be performed in high myopes with strabismus to assess extraocular muscle pathways.


Assuntos
Encefalopatias/diagnóstico , Esotropia/cirurgia , Hérnia/etiologia , Miopia/cirurgia , Neurofibromatose 1/diagnóstico , Músculos Oculomotores/cirurgia , Adulto , Encefalopatias/etiologia , Diagnóstico Diferencial , Esotropia/diagnóstico , Esotropia/etiologia , Hérnia/diagnóstico , Humanos , Imagem por Ressonância Magnética , Masculino , Miopia/diagnóstico , Miopia/etiologia , Neurofibromatose 1/complicações , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/patologia , Lobo Temporal/diagnóstico por imagem , Resultado do Tratamento , Acuidade Visual
6.
J Oral Maxillofac Surg ; 78(11): 1909-1918, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32640204

RESUMO

PURPOSE: The aim of the present study was to increase awareness of an underreported surgical complication by presenting the relevant findings of cases of herniated oroantral sinonasal polyp (OASNP) identified from our biopsy service and from previously reported cases. MATERIALS AND METHODS: The present study was a retrospective descriptive case series with a review of the reported data. Cases of OASNP were identified from our biopsy service, and the clinical, radiographic, surgical, and demographic information was retrieved. Previously reported cases of OASNP were also reviewed. RESULTS: We identified 14 cases of OASNP in our biopsy service and an additional 10 reported cases. Overall, OASNP was more prevalent in males (71%). The age range was 19 to 85 years (overall mean, 46.6 years; median, 43.5 years). OASNP typically presented as a red polypoid mass that was frequently pedunculated with a smooth or granular surface. The lesions were located on the maxillary alveolus in the molar region. The most commonly implicated tooth was a maxillary first molar (74%). In some cases, the OASNP had been mistaken for a tumor or pyogenic granuloma. Almost all were at least 1 cm in the greatest dimension, with 43% measuring at least 2 cm in size, and 1 lesion reaching 5 cm in diameter. The reported period for development of the lesion ranged from 2 days to 5 years, with 60% developing within 2 months of the extraction. All lesions had undergone surgical excision. Antibiotic use and surgical closure of the oroantral communication had been described for some of the cases. CONCLUSIONS: The results from our study suggest that herniation of a sinonasal polyp through an oroantral defect could be an underreported complication of maxillary exodontia. Additional research would help to enhance our knowledge and understanding of this interesting condition.


Assuntos
Fístula Bucoantral , Extração Dentária , Adulto , Idoso , Idoso de 80 Anos ou mais , Hérnia/diagnóstico por imagem , Hérnia/etiologia , Humanos , Masculino , Maxila , Pessoa de Meia-Idade , Fístula Bucoantral/etiologia , Estudos Retrospectivos , Extração Dentária/efeitos adversos , Adulto Jovem
7.
J Cardiothorac Surg ; 15(1): 159, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32611350

RESUMO

BACKGROUND: Congenital pulmonary airway malformation is a rare congenital lung lesion. Infants with large Congenital pulmonary airway malformation can present with a series of serious symptoms. Surgery is still the main treatment. Thoracoscopic lobectomy for neonates is rarely reported. CASE PRESENTATION: The authors report a case of a congenital pulmonary airway malformation located in the left lower lung of a 4-day-old female infant. Prenatally, the cystic adenomatoid malformation volume ratio was 2.99 according to ultrasound scan. After birth, thoracoscopic lobectomy was performed to alleviate respiratory failure and mediastinal hernia. The patient's clinical symptoms and the X-ray re-examination showed good postoperative recovery. CONCLUSIONS: The purpose of this study is to indicate that a safe and effective minimally invasive surgery for the giant congenital pulmonary airway malformation is feasible, even for infants only 4 days old.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Pneumonectomia/métodos , Toracoscopia/métodos , Malformação Adenomatoide Cística Congênita do Pulmão/complicações , Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico por imagem , Feminino , Hérnia/etiologia , Herniorrafia , Humanos , Recém-Nascido , Doenças do Mediastino/etiologia , Doenças do Mediastino/cirurgia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/cirurgia , Ultrassonografia Pré-Natal
9.
Ulus Travma Acil Cerrahi Derg ; 26(4): 639-641, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32589254

RESUMO

Trocar site hernias are a type of incisional hernias and may occur within a variable time shift after surgery. A mean incidence of 1.85% was reported, and the first trocar site hernia was narrated by Maio et al. in 1991 describing small bowel obstruction due to trocar site herniation after laparoscopic cholecystectomy. The 10-mm-trocar port is more frequently problematic, and a trocar site hernia in 5 mm port is very rare. This report unveils a 5mm trocar site herniation of right fallopian tube following laparoscopic appendectomy. In this case study, a 19-year-old female patient applied to the emergency department because of a discharge in the right lower quadrant was reported. She explained that she had undergone laparoscopic appendectomy two days before and discharged the next day uneventfully. The surgical report described a suction drain in the right lower quadrant where the patient was suffering from the discharge. The physical examination revealed no tenderness, but an abdominal CT disclosed an edematous tubular structure herniating from the 5 mm trocar site where the drain was put. She was re-operated laparoscopically due to early trocar site hernia, and the right fallopian tube was observed herniating through the defect. After the reduction into the abdomen, the fallopian tube was observed fine, and the defect was closed using 2/0 polypropylene suture. Trocar site hernias are rare but may cause serious complications after laparoscopic surgery. They may occur early after the surgery, but the time shift is variable. Although mechanical bowel obstructions are more frequent endpoint, it should be remembered that any organ within the abdominal cavity may herniate.


Assuntos
Apendicectomia/efeitos adversos , Tubas Uterinas/fisiopatologia , Hérnia , Laparoscopia/efeitos adversos , Instrumentos Cirúrgicos/efeitos adversos , Adolescente , Feminino , Hérnia/diagnóstico , Hérnia/etiologia , Hérnia/fisiopatologia , Humanos
11.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(1): 9-13, ene.-mar. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-187066

RESUMO

Las hernias intestinales a través de defectos en el ligamento ancho son un cuadro clínico poco frecuente y de difícil diagnóstico. La sospecha diagnóstica y el tratamiento precoz de esta entidad son de vital importancia. Su etiología está ampliamente relacionada con intervenciones quirúrgicas previas y traumatismos asociados a gestaciones y partos previos. Tanto la clínica como las determinaciones analíticas asociadas a esta patología son inespecíficas; siendo la tomografía axial computarizada la prueba de imagen complementaria de elección para el diagnóstico y valoración de la viabilidad de los órganos afectados herniados. Históricamente la resolución de las hernias se asociaba al abordaje laparotómico. Hoy en día sabemos que las vías de abordaje mínimamente invasivas, como la laparoscópica, son factibles, y deben ser la primera elección, pudiendo además aportar beneficios en términos de recuperación y postoperatorio favorable. Presentamos el caso clínico de una hernia interna de intestino delgado a través de un defecto del ligamento ancho izquierdo, en una paciente sin antecedentes quirúrgicos ni traumáticos previos, cuyo diagnóstico y resolución requirió de la realización de una laparotomía exploradora


Intestinal hernias through the broad ligament are a rare entity and difficult to diagnose. The diagnostic suspicion and early treatment are of vital importance. Its aetiology is widely associated with previous surgical interventions and trauma associated with previous pregnancies and deliveries. Both the clinical and the analytical tests associated with this entity are non-specific. Computed axial tomography is the complementary imaging test of choice for the diagnosis and assessment of the viability of the organs involved in the hernia. Historically, the resolution of hernias was associated with the laparotomy approach. Nowadays, it is known that the use of the minimum invasion by laparoscopy is feasible, and should be of first choice, and may also provide benefits in recovery and a more favourable post-operative period. A clinical case is presented of an internal hernia of the small intestine, through a defect of the left broad ligament, in a patient with no prior surgical or traumatic history, in which the diagnosis and resolution of the condition involved the performing of an exploratory laparotomy


Assuntos
Humanos , Feminino , Adulto , Intestino Delgado/patologia , Hérnia/complicações , Ligamento Largo/anormalidades , Obstrução Intestinal/etiologia , Hérnia/etiologia , Obstrução Intestinal/complicações , Laparoscopia , Ultrassonografia , Hérnia/diagnóstico por imagem , Herniorrafia , Apendicectomia , Diagnóstico Diferencial , Dor Abdominal/etiologia
12.
Lancet ; 395(10222): 417-426, 2020 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-32035551

RESUMO

BACKGROUND: Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. METHODS: In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. FINDINGS: Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43-0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26-0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60-1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54-1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. INTERPRETATION: Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. FUNDING: National Institute for Health Research Research for Patient Benefit and Allergan.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Hérnia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas , Estomas Cirúrgicos , Adulto , Idoso , Colágeno , Colo/cirurgia , Método Duplo-Cego , Feminino , Hérnia/etiologia , Hérnia/prevenção & controle , Humanos , Íleus/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos
14.
Eur Radiol ; 30(4): 2138-2141, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31953667

RESUMO

BACKGROUND: Lacrimal gland (LG) involvement in patients with Graves ophthalmopathy (GO) has been considered as a potential cause of the associated GO symptoms and different studies demonstrated the LG involvement in patients with GO than healthy controls. The aim of this study was to evaluate LG involvement, through measurement of its herniation, using a magnetic resonance imaging (MRI) index, in patients with different GO activities. METHODS: Thirty-two consecutive Caucasian patients affected by GO were enrolled and grouped in group A (16 with inactive GO, CAS < 3) and B (16 with active GO, CAS ≥ 3) according to their GO activity. All patients underwent clinical-endocrinological assessment, a complete ocular evaluation, and orbital MRI examination. RESULTS: No difference was found between the hormonal parameters, thyroid ultrasound-derived parameters, and thyroid-stimulating hormone (TSH) receptor (TSH-R) antibodies (TRAb) levels in group B and those in group A. The LG herniation (LGH) measurement evaluated by MRI was significantly higher in group B for both right (10.1 (7.3-17) vs. 7 (0-3.4) mm; p = 0.004) and left (8.5 (6.6-13) vs. 5.8 (0-12) mm; p = 0.026) eye than group A. A positive correlation was found between TRAb and LGH herniation (Rho 0.462, p = 0.009). CONCLUSIONS: Measurement of LGH seems to be a good marker of the disease and GO activity. KEY POINTS: • Lacrimal gland herniation is a simple index related to disease activity • Lacrimal gland herniation is correlated to TRAb levels • Lacrimal gland evaluation could be useful to differentiate active from inactive Graves ophthalmopathy in an early stage of disease.


Assuntos
Oftalmopatia de Graves/complicações , Hérnia/diagnóstico , Aparelho Lacrimal/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Feminino , Oftalmopatia de Graves/diagnóstico , Hérnia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
15.
BMC Surg ; 20(1): 14, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31948420

RESUMO

BACKGROUND: An intro-abdominal hernia through the lesser omentum is a rare but severe condition that can cause intestinal obstruction and other life-threating complications. Until now, only a handful of cases have been reported worldwide. The diagnosis of lesser omental hernia remains challenging for emergency surgeons because of the unspecific symptoms. Therefore, there is a need for a better understanding of the characteristics of this condition. CASE PRESENTATION: In this report, we described the case of a 73-year-old female patient who was diagnosed with a lesser omental hernia caused by previous total colectomy. The patient underwent emergency surgery, and the intraoperative findings revealed a 200-cm segment of the small intestine was herniated through a defected lesser omentum (approximately 3 × 4 cm) from the lesser retrogastric curvature of the stomach. Besides, we summarize the specific abdominal computed tomography (CT) findings of lesser omental hernia by reviewing the literature. CONCLUSION: The lesser omental hernia is extremely rare but can cause serious complications. The cause of lesser omental hernia can be congenital or acquired. Careful examination of the small omentum before the closure of the abdomen is expected to reduce the occurrence of these abdominal surgery-associated complications. The specific features of abdominal CT in cases of lesser omental hernia, which are summarized in this article, can help other clinicians to obtain accurate diagnoses of lesser omentum hernia in the future.


Assuntos
Colectomia/efeitos adversos , Hérnia/etiologia , Omento/patologia , Idoso , Emergências , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Omento/cirurgia , Doenças Peritoneais/patologia , Tomografia Computadorizada por Raios X
16.
Am J Emerg Med ; 38(4): 851.e5-851.e6, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31837904

RESUMO

Spontaneous lung herniation is a rare finding, most often the result of forceful coughing. Risk factors include obesity, male gender, tobacco use, and steroid use. Surgical repair is recommended due to increasing size of herniation and pain control. Life style modification, such as smoking cessation, is recommended in this patient population.


Assuntos
Tosse/complicações , Hérnia/etiologia , Pneumopatias/etiologia , Hérnia/diagnóstico por imagem , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
17.
Ann R Coll Surg Engl ; 102(3): e73-e74, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845821

RESUMO

Lung herniation is a rare entity, defined as a protrusion of the lung above the normal confines of thorax; it is caused by increased intrathoracic pressure and defects or weakness of the chest wall. Intercostal lung hernia can occur spontaneously or following thoracic trauma or surgery. Postoperative hernias are more commonly associated with less extensive surgical procedures, such as thoracoscopic surgery or mini-thoracotomy incisions, rather than with major thoracic procedures. We describe the first reported case of postoperative intercostal lung hernia following two-stage totally minimally invasive oesophagectomy for cancer, together with its successful surgical repair.


Assuntos
Esofagectomia/efeitos adversos , Hérnia/etiologia , Pneumopatias/etiologia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-Operatórias , Adenocarcinoma/cirurgia , Idoso , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Hérnia/terapia , Herniorrafia/métodos , Humanos , Pneumopatias/cirurgia , Masculino , Reoperação , Toracotomia/métodos
18.
Int J Artif Organs ; 43(2): 94-98, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31544578

RESUMO

Magnetic resonance and computed tomography peritoneography are diagnostic imaging procedures that involve the intraperitoneal administration of a mixture of contrast material and dialysate for direct visualization of the peritoneal cavity and assessment of the integrity of peritoneal membrane. In a clinical series of patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis, who presented with genital or low abdominal edema, advanced peritoneographic imaging studies allowed direct visualization of the dialysate leakage and peritoneal hernias. Both magnetic resonance and computed tomography peritoneographic procedures allowed accurate diagnosis of continuous ambulatory peritoneal dialysis-related complications that may need to be addressed promptly so that the effectiveness of continuous ambulatory peritoneal dialysis is not compromised.


Assuntos
Soluções para Diálise/farmacologia , Edema , Hérnia , Imagem por Ressonância Magnética/métodos , Cavidade Peritoneal/diagnóstico por imagem , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Edema/diagnóstico por imagem , Edema/etiologia , Feminino , Hérnia/diagnóstico por imagem , Hérnia/etiologia , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal Ambulatorial Contínua/métodos , Reprodutibilidade dos Testes
20.
Gen Thorac Cardiovasc Surg ; 68(4): 403-407, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31187412

RESUMO

BACKGROUND: It is quite rare for lung to herniate between a patient's ribs, most often seen after surgery; it is, however, also rarely seen in other situations, notably during coughing fits situations such as coughing spells. There is minor controversy in the literature regarding management, namely, a question of whether to manage conservatively or with surgical correction, since this is such a rare entity physicians, may face difficulty in knowing how to proceed. Here, we provide evidence supporting acquired lung herniation management to be repaired surgically, and early, while at the same time medically optimizing the patient's risk factors for further herniation events or intercostal muscle tears. PRESENTATION: We report a 79-year-old man who suffered a right-sided lung herniation as a result of vigorous coughing, he initially was managed conservatively, and symptoms worsened but then underwent surgical repair which was associated with a suitable outcome. CONCLUSION: Lung herniation will may resolve on its own and prompt correction should be considered instead of conservative management. We recommend early surgical repair for all intercostal lung herniations, even if they are asymptomatic, to prevent complications or extension of the defect into the abdominal wall. Surgery may offer the best results, with low morbidity and no mortality reported to date.


Assuntos
Tratamento Conservador/efeitos adversos , Hérnia/etiologia , Pneumopatias/cirurgia , Idoso , Dor no Peito , Tosse/complicações , Hérnia/terapia , Herniorrafia , Humanos , Pneumopatias/etiologia , Masculino , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Costelas/cirurgia , Fatores de Risco , Tomografia Computadorizada por Raios X
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