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1.
BMJ Case Rep ; 11(1)2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30567185

RESUMO

Patent foramen ovale (PFO) is a congenital abnormality present in 25%-30% of healthy adults and rarely leads to any sequelae. 1 2 It is associated with a left-to-right shunt which usually does not lead to any haemodynamic compromise. Occasionally, the shunt can get reversed; that is, right-to-left shunt occurs due to worsening pulmonary hypertension and can lead to persistent hypoxia. It is rare for the shunt reversal to happen in the absence of pulmonary hypertension. Here, we present an exceedingly rare case in a 61-year-old man presenting with hypoxia, was found to have shunt reversal due to unilateral diaphragmatic paralysis. He was successfully treated with PFO closure. The purpose of this report is to consider rare possibilities of PFO shunt reversal when the right-sided heart pressure is normal and to highlight that a simple chest X-ray can be a clue to the diagnosis.


Assuntos
Forame Oval Patente/diagnóstico , Paralisia Respiratória/diagnóstico , Adulto , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Humanos , Hipertensão Pulmonar/etiologia , Hipóxia/etiologia , Masculino , Paralisia Respiratória/complicações , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/cirurgia
2.
J Cardiothorac Surg ; 13(1): 98, 2018 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-30257688

RESUMO

BACKGROUND: Diaphragmatic plication to help ventilation weaning of an adult obese patient after cardiac surgery is very uncommon. Diaphragm paralysis is usually treated with conservative measures and ventilator support, after which surgical management is considered after months of medical monitoring. CASE PRESENTATION: We report the case of a morbidly obese patient to whom ventilation weaning was unsuccessful following coronary artery bypass graft operation with mitral valve replacement. A de novo right hemidiaphragm elevation was seen on the chest X-ray. Diaphragmatic plication was performed promptly to treat severe respiratory insufficiency and generated favorable outcomes. CONCLUSIONS: Early diaphragmatic plication could be considered in the postoperative period of cardiothoracic surgery to facilitate management and ventilation weaning in the context of de novo diaphragm paralysis.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Diafragma/cirurgia , Obesidade Mórbida/complicações , Complicações Pós-Operatórias , Paralisia Respiratória/cirurgia , Idoso , Humanos , Masculino , Reoperação , Paralisia Respiratória/etiologia , Desmame do Respirador
3.
Khirurgiia (Mosk) ; (3. Vyp. 2): 4-14, 2018.
Artigo em Russo | MEDLINE | ID: mdl-29652316

RESUMO

AIM: To develop examination algorithm and to determine the indications for various options for surgical treatment. MATERIAL AND METHODS: It is presented analysis of surgical treatment of 25 patients with unilateral diaphragm relaxation for the period from 1963 to 2016. There were 15 men and 10 women aged from 39 to 65 years. Diagnosis included predominantly radiological methods. All patients were operated openly through thoracotomy. Procedure consisted of creation of new diaphragmatic cupola at the usual level with two flaps of diaphragm and prosthesis between them. In 12 (48%) patients who were operated before 1990 xenopericardial patch was used. Further, synthetic materials (Teflon, polypropylene) were preferred. RESULTS: Postoperative morbidity and mortality was 20% (n=6) and 4% (n=1) respectively. Long-term results were followed-up within terms from 8 months to 12 years. Recurrent relaxation was absent. Most of patients had improved dyspnea, increased vital capacity and FEV1 in long-term period. Certain and general values of SF-36 life quality questionnaire were high in long-term postoperative period and similar to those in general population.


Assuntos
Diafragma/cirurgia , Paralisia Respiratória/cirurgia , Adulto , Idoso , Algoritmos , Dispneia/etiologia , Dispneia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia Respiratória/complicações , Retalhos Cirúrgicos , Toracotomia
4.
Eur J Cardiothorac Surg ; 53(1): 247-253, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-28977536

RESUMO

OBJECTIVES: Diaphragmatic paralysis, a known cause of dyspnoea, can drastically reduce breathing efficiency, diminishing quality of life. We report our 3.5-year experience with 22 consecutive patients who underwent transabdominal, robot-assisted diaphragmatic plication for diaphragmatic paralysis. METHODS: We retrospectively reviewed 22 consecutive patients who underwent this procedure by a single surgeon from 5 September 2012 to 12 May 2016. The primary outcome measure was change in dyspnoea severity, which was measured with the 5-point Medical Research Council dyspnoea scale (a score of 5 indicates breathlessness so severe, the individual is homebound). RESULTS: Of the 22 patients who underwent robotic diaphragmatic plication, 17 (77.3%) patients were male. Median body mass index was 30 kg/m2 (range 24.2-42.17 kg/m2). Most plications (13 of 22, 59.1%) were left sided; one (4.6%) was bilateral. Median operating time was 161 min (range 107-293 min), but this time was higher for the first 3 procedures (255 min, range 239-293 min). Median length of stay was 2 days, and median time to chest tube removal was 1 day. At follow-up, 20 of the 22 (91%) patients reported improved breathing and 2 reported no change. No patient reported worsened dyspnoea. The median Medical Research Council score changed from 4.0 preoperatively to 2.0 postoperatively (P = 0.001). CONCLUSIONS: Transabdominal robotic diaphragmatic plication involves small incisions but improves surgical dexterity. Surgical times are reasonable, and this surgical technique can be adopted with a quick but steep learning curve. Early results show good functional outcomes.


Assuntos
Diafragma/cirurgia , Paralisia Respiratória/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Abdome/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
Innovations (Phila) ; 12(6): 398-405, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29219945

RESUMO

OBJECTIVE: The aim of the study was to report the safety and efficacy of video-assisted thoracoscopic (VATS) plication of the diaphragm at our institution between 2006 and 2016. METHODS: Adult patients selected on etiology and combination of investigations including plain chest x-ray, computed tomography of chest and abdomen, lung functions in supine and sitting positions, radiological/ultrasonic screening for diaphragmatic movement, and phrenic nerve conduction studies. We incorporated a triportal VATS and Endostitch device for plication, using CO2 insufflation to maximum 12 mm Hg. Bilateral simultaneous plication and high-risk patients were electively admitted to intensive therapy unit postoperatively. RESULTS: Thirty-five patients (24 males) had their diaphragm plicated. The mean age was 56.6 years (range = 23-76 years). The mean body mass index was 32.1 (range = 22.2-45.4). Twenty one were right, 13 left, 2 patients had VATS simultaneous bilateral plication, and 1 had sequential VATS bilateral plication. Paralysis was idiopathic in 17, posttraumatic in 5, postremoval of mediastinal tumor in 4, and postcardiac surgery in 3. All patients presented with lifestyle-limiting dyspnea and orthopnea, three were on nocturnal noninvasive ventilation. Five were diabetic and 16 were smokers. The mean supine forced expiratory volume in the first second was 62.5% of predicted. Twenty two were performed by VATS (63%), three converted to thoracotomy, and 13 were open limited thoracotomy (historic). The mean hospital stay was 4.5 days (range = 1-18, mode 2 days). Intensive therapy unit admission was required in six patients for mechanical ventilation 0 to 3 days. Five patients (14%) had no improvement in symptoms. There were no deaths, no 30-day readmissions, and no long-term neuralgia in this series. CONCLUSIONS: We found minimal access VATS plication of the diaphragm to be feasible and safe, but no firm conclusions should be drawn from our limited resources. We report the feasibility of concomitant bilateral VATS plication of the diaphragm in two adults, and this was not previously reported in the adult population. There is a need for further good quality, prospective studies, and randomized controlled studies evaluating efficacy of VATS diaphragmatic plication.


Assuntos
Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Paralisia Respiratória/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Eventração Diafragmática/etiologia , Eventração Diafragmática/fisiopatologia , Feminino , Volume Expiratório Forçado , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/complicações , Nervo Frênico , Paralisia Respiratória/etiologia , Paralisia Respiratória/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
A A Case Rep ; 9(10): 280-282, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-28691979

RESUMO

The optimal approach to postoperative analgesia in patients with bilateral diaphragmatic paralysis undergoing abdominal surgery remains unclear. We report a 69-year-old woman with bilateral diaphragmatic paralysis who underwent a laparoscopic hernia repair and an open laparotomy for reversal of a Hartmann procedure under general anesthesia. Postoperative analgesia was provided by intravenous opioid and epidural local anesthetic and opioid, respectively. The patient's trachea was successfully extubated at the end of both surgical procedures. Epidural analgesia was associated with better pain control and shorter intensive care unit stay.


Assuntos
Analgésicos Opioides/administração & dosagem , Hérnia Abdominal/cirurgia , Paralisia Respiratória/cirurgia , Administração Intravenosa , Idoso , Anestesia Epidural , Feminino , Herniorrafia/efeitos adversos , Humanos , Manejo da Dor/métodos , Assistência Perioperatória
7.
Ann Thorac Surg ; 104(1): e9-e11, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28633275

RESUMO

A 49-year-old man with left phrenic nerve paralysis caused by mediastinal tumor resection 28 years earlier was found to have a nodule in the right upper lobe. The right phrenic nerve was severed during right upper lobectomy but was reconstructed along with bilateral plication of the diaphragm. The patient was weaned from the ventilator during the daytime on postoperative day 13 and was discharged home on postoperative day 48. Three months postoperatively, chest fluoroscopic imaging showed recovery of movement of the right diaphragm. Nerve conduction studies showed improvement of function of the reconstructed right phrenic nerve.


Assuntos
Diafragma/cirurgia , Neoplasias Pulmonares/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Nervo Frênico/cirurgia , Pneumonectomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Paralisia Respiratória/cirurgia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Diafragma/inervação , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/diagnóstico , Nervo Frênico/lesões , Radiografia Torácica , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/etiologia , Tomografia Computadorizada por Raios X
8.
Crit Care Med ; 45(7): e691-e694, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28441238

RESUMO

OBJECTIVES: Over 30% of critically ill patients on positive-pressure mechanical ventilation have difficulty weaning from the ventilator, many of whom acquire ventilator-induced diaphragm dysfunction. Temporary transvenous phrenic nerve pacing using a novel electrode-bearing catheter may provide a means to prevent diaphragm atrophy, to strengthen an atrophied diaphragm, and mitigate the harms of mechanical ventilation. We tested the initial safety, feasibility, and impact on ventilation of this novel approach. DESIGN: First-in-Humans case series. SETTING: Angiogram suite. PATIENTS: Twenty-four sedated, mechanically ventilated patients immediately prior to an elective atrial septal defect repair procedure. INTERVENTIONS: A 9.5-Fr central venous catheter with 19 embedded electrodes was placed via Seldinger technique into the left subclavian vein and superior vena cava and evaluated for up to 90 minutes. The electrode combinations determined to provide best transvenous stimulation of the right and left phrenic nerves were activated in synchrony with mechanically ventilated breaths. MEASUREMENTS AND MAIN RESULTS: One patient could not be tested for reasons unrelated to the device. In the 23 patients who underwent the full protocol, transvenous stimulation activated the diaphragm in 22 of 23 (96%) left phrenic capture attempts and 20 of 23 (87%) right phrenic capture attempts. In one subject, a congenital left-sided superior vena cava precluded right-sided capture. Significant reductions in ventilator pressure-time-product were achieved during stimulation assisted breaths in all 22 paced subjects (range, 9.9-48.6%; p < 0.001). There were no adverse events either immediately or at 2-week follow-up. CONCLUSIONS: In this First-in-Human series, diaphragm pacing with a temporary catheter was safe and effectively contributed to ventilation in conjunction with a mechanical ventilator.


Assuntos
Diafragma/inervação , Terapia por Estimulação Elétrica/métodos , Nervo Frênico , Respiração Artificial/efeitos adversos , Paralisia Respiratória/etiologia , Paralisia Respiratória/cirurgia , Terapia por Estimulação Elétrica/instrumentação , Humanos , Neuroestimuladores Implantáveis
9.
J Thorac Cardiovasc Surg ; 153(5): 1182-1188, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28087113

RESUMO

OBJECTIVE: Surgeons have hesitated to adopt minimally invasive diaphragm plication techniques because of technical limitations rendering the procedure cumbersome or leading to early failure or reduced efficacy. We sought to demonstrate efficacy and durability of our thoracoscopic plication technique using a single running suture. METHODS: We retrospectively reviewed patients who underwent our technique for diaphragm plication since 2008. We used a single, buttressed, double-layered, to-and-fro running suture with additional plicating horizontal mattress sutures as needed. RESULTS: Eighteen patients underwent thoracoscopic plication from 2008 to 2015. There were no operative mortalities and 2 unrelated late deaths. Median hospital stay was 3 days (range, 1-12). Atrial fibrillation occurred in 1 patient (5.5%), pneumonia occurred in 2 patients (11%), reintubation occurred in 1 patient (5.5%), and ileus occurred in 1 patient (5.5%). Of 14 patients with complete follow-up, median follow-up was 29.4 months (range, 3.4-84.7). Significant increases between preoperative and postoperative pulmonary function tests (% predicted values) were found for mean forced expiratory volume in 1 second (73.5% ± 3.5% to 88.8% ± 4.5%, P = .002) and mean forced vital capacity (70.6% ± 3.5% to 82.3% ± 3.5%, P = .002). Preoperative mean Baseline Dyspnea Index was 8.1 ± 0.7. Mean Transitional Dyspnea Index 6 months postoperatively was 7.1 ± 0.6 (moderate to major improvement). Transitional Dyspnea Index at last contact (median 29.4 months postoperatively) was 7.2 ± 0.6 (P = .38). Compared with previously published results, this is at least equivalent. CONCLUSIONS: Thoracoscopic diaphragm plication with a running suture is safe and achieves excellent early and long-term improvements. This addresses technical challenges of tying multiple interrupted sutures by video-assisted thoracoscopic surgery without any apparent compromise to efficacy or durability.


Assuntos
Diafragma/cirurgia , Paralisia Respiratória/cirurgia , Técnicas de Sutura , Cirurgia Torácica Vídeoassistida , Idoso , Diafragma/diagnóstico por imagem , Diafragma/fisiopatologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Cirurgia Torácica Vídeoassistida/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
10.
J Reconstr Microsurg ; 33(1): 63-69, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27665114

RESUMO

Background Phrenic nerve reconstruction has been evaluated as a method of restoring functional activity and may be an effective alternative to diaphragm plication. Longer follow-up and a larger cohort for analysis are necessary to confirm the efficacy of this procedure for diaphragmatic paralysis. Methods A total of 180 patients treated with phrenic nerve reconstruction for chronic diaphragmatic paralysis were followed for a median 2.7 years. Assessment parameters included: 36-Item Short Form Health Survey (SF-36) physical functioning survey, spirometry, chest fluoroscopy, electrodiagnostic evaluation, a five-item questionnaire to assess specific functional issues, and overall patient-reported outcome. Results Overall, 134 males and 46 females with an average age of 56 years (range: 10-79 years) were treated. Mean baseline percent predicted values for forced expiratory volume in 1 second, forced vital capacity, vital capacity, and total lung capacity, were 61, 63, 67, and 75%, respectively. The corresponding percent improvements in percent predicted values were: 11, 6, 9, and 13% (p ≤ 0.01; ≤ 0.01; ≤ 0.05; ≤ 0.01). Mean preoperative SF-36 physical functioning survey scores were 39%, and an improvement to 65% was demonstrated following surgery (p ≤ 0.0001). Nerve conduction latency, improved by an average 23% (p ≤ 0.005), and there was a corresponding 125% increase in diaphragm motor amplitude (p ≤ 0.0001). A total of 89% of patients reported an overall improvement in breathing function. Conclusion Long-term assessment of phrenic nerve reconstruction for diaphragmatic paralysis indicates functional correction and symptomatic relief.


Assuntos
Diafragma/inervação , Procedimentos Neurocirúrgicos/métodos , Nervo Frênico/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Paralisia Respiratória/cirurgia , Adolescente , Adulto , Idoso , Criança , Diafragma/fisiopatologia , Diafragma/cirurgia , Eletromiografia , Feminino , Fluoroscopia , Seguimentos , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Paralisia Respiratória/fisiopatologia , Estudos Retrospectivos , Espirometria , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
11.
World J Surg ; 41(4): 1019-1022, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27822722

RESUMO

BACKGROUND: Thoracoscopic diaphragmatic plication for diaphragmatic paralysis with consecutive eventration and respiratory compromise is a desirable alternative to standard thoracotomy. Since minimally invasive techniques usually involve suturing of the diaphragm, most surgeons use a video-assisted approach with a minithoracotomy. Herein we describe our completely thoracoscopic technique for diaphragmatic plication including outcome. METHODS: We present our technique and experience for completely thoracoscopic diaphragmatic plication for the treatment of symptomatic diaphragmatic paralysis in six consecutive patients. The surgical technique basically consisted of stapling of the abundant diaphragm and reinforcement of the staple line using a self-locking thread. Primary outcome measure was the postoperative result (flattened diaphragm) and resolution of symptoms. Secondary outcome was improvement of lung function values 3 months after surgery. RESULTS: Between June 2015 and March 2016, six patients have been operated for symptomatic diaphragmatic paralysis, with one of them suffering from additional transdiaphragmatic hernia. Flattening of the diaphragm was achieved in all 6 patients with resolution of their pre-existing symptoms within days after surgery and without any surgical complications. Lung function volumes measured 3 months postoperative improved markedly with an increase in FEV1 as well as FVC of 540 ml (SD ± 193 ml) and 776 ml (SD ± 121 ml), respectively. CONCLUSIONS: In our experience, the presented technique is a safe and simple minimally invasive way to perform a completely thoracoscopic diaphragmatic plication with excellent results so far.


Assuntos
Diafragma/cirurgia , Paralisia Respiratória/cirurgia , Toracoscopia/métodos , Idoso , Idoso de 80 Anos ou mais , Dispneia/etiologia , Dispneia/cirurgia , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Capacidade Vital
12.
Surg Endosc ; 31(4): 1772-1777, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27519592

RESUMO

BACKGROUND: Diaphragmatic plication is an approved surgical procedure for treatment of symptomatic diaphragmatic paralysis and eventration. We aim to define our minimally invasive technique of plication and objectively assess our surgical outcomes of the largest series reported in the literature so far, using pulmonary function tests. METHODS: Symptomatic patients whom were planned to undergo plication using video-assisted mini-thoracotomy between December 2009 and December 2015 were the cohort of this retrospective study. Single camera port and a utility incision (3-4 cm) were used for access. Data of patient demographics with preoperative and postoperative spirometric results were collected for statistical comparison. RESULTS: Procedure (30 left, 7 right) was completed in 37 (27 male, 10 female) patients. One patient was excluded because of insufficient objective postoperative comparison criteria due to previous permanent tracheostomy. Mean length of surgery was 48.8 ± 19.7 (range: 30-70) min. Postoperative overall morbidity was 8.3 %, with no mortality. The mean length of hospital stay was 3.1 ± 1.7 days. All patients except one (97.3 %) were asymptomatic on discharge and on follow-ups. Significant improvement in measurements of forced expiratory volume in 1st second was observed on postoperative measurements (P < 0.001), with a mean overall increase of 13 % in whole cohort. No recurrence was detected throughout a mean follow-up of 19 months. CONCLUSIONS: Diaphragmatic plication via video-assisted mini-thoracotomy is an effective and curative surgical procedure which can be performed successfully with low morbidity rates. As it combines the rapidity and economical benefits of open thoracotomy with the advantages of video thoracoscopic procedures such as fast recovery and short postoperative hospital stay, it can be preferred as a safe and effective alternative hybrid method compared to standard open or closed techniques, for symptomatic patients with non-functional hemidiaphragm.


Assuntos
Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Paralisia Respiratória/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Adulto , Idoso , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
13.
Zentralbl Chir ; 141 Suppl 1: S43-9, 2016 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-27607888

RESUMO

Unilateral elevation of the diaphragm may be due to various causes and requires further elucidation when the aetiology is unknown. Elevation of the diaphragm is often caused by diaphragmatic paralysis, either due to damage to the phrenic nerve or to the phrenic muscle. Patients typically complain of increased respiratory distress when lying down, bending or swimming. Basic diagnostic testing consists of a chest X-ray, as well as spirometry and computer tomography of the neck and chest. In many cases, no cause can be identified for the diaphragmatic paralysis. In symptomatic patients, diaphragm plication leads to fixation and thus to a reduction in the paradoxal respiratory movement of the paralysed diaphragm. In a large majority of studies, this results in significant and lasting improvement in vital capacity and respiratory distress. Spontaneous recovery of diaphragm paralysis is possible, even after several months, so a waiting period of at least 6 months should elapse before diaphragmatic plication is performed, if the clinical situation allows. The procedure can be performed minimally invasively, with low morbidity and mortality. When cutting the phrenic nerve, a nerve suture is recommended, if possible, or otherwise diaphragm plication during the procedure, especially in the case of pneumonectomy. This review provides an overview of the causes, pathophysiology, symptoms, diagnosis, therapy and results of diaphragmatic plication in acquired, unilateral diaphragmatic paralysis in adults, and suggests an algorithm for diagnostic testing and therapy.


Assuntos
Paralisia Respiratória/cirurgia , Algoritmos , Humanos , Imagem por Ressonância Magnética , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/etiologia , Remissão Espontânea , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/etiologia , Técnicas de Sutura , Procedimentos Cirúrgicos Torácicos/métodos , Tomografia Computadorizada por Raios X , Ultrassonografia
14.
Thorac Surg Clin ; 26(3): 333-46, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27427528

RESUMO

Diaphragmatic eventration and diaphragmatic paralysis are 2 entities with different etiology and pathology, and are often clinically indistinguishable. When symptomatic, their treatment is the same, with the objective to reduce the dysfunctional cephalad excursion of the diaphragm during inspiration. This can be achieved with diaphragmatic plication through the thorax or the abdomen with either open or minimally invasive techniques. We prefer the laparoscopic approach, due to its easy access to the diaphragm and to avoid pain associated with intercostal incisions and instrument use. Short-term and long-term results are excellent with this technique.


Assuntos
Diafragma/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Paralisia Respiratória/cirurgia , Toracoscopia/métodos , Humanos
15.
Surg Technol Int ; 28: 222-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27175808

RESUMO

Elevated diaphragm can be due to diaphragmatic eventration or diaphragm paralysis. Diaphragm paralysis is a rare condition that can be congenital or acquired. Acquired diaphragmatic paralysis can result from injury to the phrenic nerve. Subsequently, there is loss of contractility of the diaphragm muscle leading to progressive atrophy and, hence, distension of the dome of the diaphragm leading to elevated right, left, or both copula of the diaphragm. Diaphragm plication aims to return the abdominal contents back to their normal position and allow for greater lung expansion by reducing the abundant diaphragmatic surface. Traditionally, diaphragm plication was performed through thoracotomy, until 1996 when Moroux introduced the widely used thoracoscopic technique of diaphragm plication. With the advancement of minimally-invasive surgery over the years, the approach to diaphragm plication has evolved from four ports to an uniportal approach and robotics.


Assuntos
Eventração Diafragmática/cirurgia , Laparoscopia/métodos , Paralisia Respiratória/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico por imagem , Medicina Baseada em Evidências , Humanos , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/etiologia , Resultado do Tratamento
16.
J Cardiothorac Surg ; 11: 25, 2016 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-26832454

RESUMO

BACKGROUND: Following diaphragmatic plication for unilateral paralysis, the effect on global chest wall function are unknown. Our hypothesis was that chest wall function would improve in both sides of the chest after plication of the paralysed side. CASE PRESENTATION: Using Optoelectronic Plethysmography, total and regional chest wall volumes were measured in one patient before and after left diaphragmatic plication. Volumes were recorded at quiet breathing. Respiratory capacity improved during quiet breathing when measured before and 6 months after surgery. These improvements occur at the abdominal-rib cage level in both operated and contralateral. Prior to surgery the abdominal rib cage motion was out of phase to the upper rib cage and abdominal compartment in both sides of the chest. Synchrony of all three compartments was restored after plication. CONCLUSION: This physiological study is the first published data in humans to show improvement in chest wall motion both in operated and contralateral side following diaphragmatic plication for unilateral paralysis.


Assuntos
Diafragma/cirurgia , Paralisia Respiratória/cirurgia , Parede Torácica/fisiopatologia , Diafragma/diagnóstico por imagem , Diafragma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pletismografia/métodos , Período Pós-Operatório , Ventilação Pulmonar/fisiologia , Radiografia , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/fisiopatologia
17.
Thorac Cardiovasc Surg ; 64(8): 631-640, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26720705

RESUMO

Introduction Diaphragmatic eventration is a congenital defect of the muscular portion of a hemidiaphragm that eventually leads to hemidiaphragmatic elevation and dysfunction. The clinical diagnosis of diaphragmatic eventration or diaphragmatic paralysis may be indistinguishable and diaphragmatic plication is the treatment of choice for both conditions. Discussion We review the indications, patient selection, and surgical techniques for diaphragmatic plication. We explain our preferred technique and guide the reader step by step on our approach. Conclusion Minimally invasive diaphragm plication techniques are effective alternatives to open transthoracic plication and result in significant improvement in dyspnea and quality of life in adequately selected patients.


Assuntos
Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Laparoscopia/métodos , Paralisia Respiratória/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Diafragma/anormalidades , Diafragma/inervação , Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico , Eventração Diafragmática/fisiopatologia , Dispneia/etiologia , Dispneia/fisiopatologia , Humanos , Laparoscopia/efeitos adversos , Seleção de Pacientes , Valor Preditivo dos Testes , Qualidade de Vida , Recuperação de Função Fisiológica , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/etiologia , Paralisia Respiratória/fisiopatologia , Fatores de Risco , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Resultado do Tratamento
18.
Thorac Cardiovasc Surg ; 64(8): 654-660, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25826679

RESUMO

Background The aim of this study was to assess long-term pulmonary and diaphragmatic function in two cohorts of patients: the first one affected by diaphragmatic palsy (DP) who underwent plication reinforced by rib-fixed mesh and the second one affected by chronic diaphragmatic hernia (TDH) who underwent surgical reduction and direct suture. Materials and Methods From 1996 to 2011, 10 patients with unilateral DP and 6 patients with TDH underwent elective surgery. Preoperative and long-term (12 months) follow-up assessments were completed in all patients, including pulmonary function tests (PFTs) with diffusion of the lung for carbon monoxide (DLCO), measure of maximum inspiratory pressure (MIP) assessed both in standing and in supine positions, blood gas analysis, chest computed tomographic (CT) scan, and dyspnea score. The Pearson chi-square test, Fisher exact test, and Student t-test were applied when indicated. Results At long-term (12 months) postoperative follow-up, patients operated for DP showed a significant improvement in terms of forced expiratory volume in 1 second (FEV1%) (+ 18.2%, p < 0.001), forced vital capacity (FVC%) (+ 12.8%, p < 0.001), DLCO% (+ 8.3%, p = 0.04), and Po 2 (+ 9.86 mm Hg, p < 0.001) when compared with baseline values. Conversely, when considering the TDH group, only the levels of Po 2 were found to be significantly higher in the postoperative assessment (+ 8.3 mm Hg, p = 0.04). Although MIP increased in both the groups after surgery, a persistent and significant decrease of MIP was detected in TDH group when comparing the levels assessed in supine position with those measured in the standing position (p < 0.001). Medical Research Council dyspnea scale improved in the DP group by a factor of 0.80 (p < 0.001) and in the TDH group by a factor of 0.33 (p = 0.175). Conclusion In patients who underwent surgery for DP, good long-term results may be predicted in terms of pulmonary flows, volumes, and DLCO. Conversely, in patients who underwent elective surgery for chronic TDH, a persistent overall restrictive pattern, lower MIP values in supine position, and paradoxical motion could be expected.


Assuntos
Diafragma/inervação , Hérnia Diafragmática/cirurgia , Herniorrafia , Pulmão/inervação , Respiração , Paralisia Respiratória/cirurgia , Procedimentos Cirúrgicos Torácicos , Adulto , Idoso , Distribuição de Qui-Quadrado , Doença Crônica , Dispneia/fisiopatologia , Dispneia/cirurgia , Procedimentos Cirúrgicos Eletivos , Feminino , Hérnia Diafragmática/diagnóstico , Hérnia Diafragmática/fisiopatologia , Herniorrafia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Pontuação de Propensão , Recuperação de Função Fisiológica , Sistema de Registros , Testes de Função Respiratória , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/fisiopatologia , Estudos Retrospectivos , Decúbito Dorsal , Técnicas de Sutura , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Clin Respir J ; 10(3): 400-3, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-25103093

RESUMO

BACKGROUND AND AIMS: Isolated phrenic nerve nodule is usually a primitive tumour. Surgery is diagnostic and therapeutic at the same time. We report the case of a completely serum-negative Caucasian male with a right diaphragmatic relaxation associated to an isolated small nodule of the phrenic nerve. METHODS: The patient was referred to our unit complaining shortness of breath and progressive fatigue. A standard chest X-ray showed right diaphragmatic palsy; chest scanning revealed a nodular lesion belonging to the right phrenic nerve. Positron emission tomography was negative for glucose uptake. The preoperative diagnosis of primitive neurogenic tumour was thus supposed, and the patient treated by the lesion's surgical resection along with diaphragmatic plication. RESULT: Histopathological examination revealed an idiopathic inflammatory nodule of the phrenic nerve. CONCLUSION: Such condition has not previously been reported in the literature among the possible aetiology of a diaphragmatic relaxation.


Assuntos
Doenças do Sistema Nervoso Periférico/cirurgia , Nervo Frênico/patologia , Paralisia Respiratória/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/diagnóstico , Nervo Frênico/cirurgia , Paralisia Respiratória/etiologia
20.
Thorac Cardiovasc Surg ; 64(8): 647-653, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25184611

RESUMO

Objectives The objective of this study was to analyze the clinical respiratory and spirometric effects of video-assisted minithoracotomy diaphragmatic plication (VAM-T DP) in the treatment of diaphragmatic eventration. Methods A retrospective longitudinal study of 18 patients who underwent a VAM-T DP in our service between February 2005 and July 2011 was performed. Data of patient characteristics, preoperative clinical variables, and postoperative results (3, 6, and 12 months) were collected for statistical analysis using the software package SPSS 13.0 for Windows (Wilcoxon test, Friedman test, and Z-test). Results The main clinical respiratory and spirometric variables improved significantly and remained stable over 1 year. Conclusions VAM-T DP is a viable and safe procedure that improves the spirometry values and offers stable results during the first year. To our knowledge, the present series is the second largest published report in English relating to this procedure in adults.


Assuntos
Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Transtornos Respiratórios/cirurgia , Respiração , Paralisia Respiratória/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diafragma/anormalidades , Diafragma/diagnóstico por imagem , Diafragma/inervação , Eventração Diafragmática/diagnóstico por imagem , Eventração Diafragmática/fisiopatologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Transtornos Respiratórios/diagnóstico por imagem , Transtornos Respiratórios/fisiopatologia , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/fisiopatologia , Estudos Retrospectivos , Espanha , Espirometria , Cirurgia Torácica Vídeoassistida/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
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