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1.
Medicine (Baltimore) ; 100(6): e24711, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578611

RESUMO

RATIONALE: Recurrent liposarcoma, previously confirmed as lipoma, has rarely been reported. However, the risk factors for recurrence and the correlation between benign lipoma and malignant liposarcoma remain unclear. In this case study, we suggest a precise diagnostic strategy to minimize recurrence and malignant transformation. PATIENT CONCERNS: A 60-year-old male patient with a history of left chest wall swelling without any symptoms underwent excisional surgery, and the mass was confirmed as a benign lipoma in 2015. In 2019, the patient returned to the hospital with symptoms of a palpable mass on the left chest wall. DIAGNOSIS: The mass was considered a recurrent lipomatous tumor with the possibility of malignant transformation. Magnetic resonance imaging (MRI) revealed a deep-seated, septate, intramuscular, irregular margin, and large lipomatous tumor invading the ribs, pleura, and adjacent muscle, suggestive of malignancy. The MRI findings were similar to those 4 years ago, except for margin irregularity and invasion to adjacent tissue. INTERVENTIONS: Wide en bloc excisions encompassing the 5th to 7th ribs, pleura, and adjacent muscle were followed by reconstruction with a pedicled latissimus dorsi muscle flap. OUTCOMES: The recurrent large lipomatous tumor was confirmed as well-differentiated liposarcomas through histological and MDM2-FISH immunohistochemical staining. Postoperatively, follow-up visits continued for 1.5 years without recurrence. LESSONS: We suggest that deep-seated, septate, and giant lipomatous tumors should be considered as risk factors for recurrence with the possibility of malignancy and misdiagnosis. It is important to inform patients of all these possibilities and plan close and long-term follow-up.


Assuntos
Lipoma/patologia , Lipossarcoma/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Torácicas/patologia , Parede Torácica/patologia , Humanos , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Lipossarcoma/diagnóstico por imagem , Lipossarcoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/cirurgia , Parede Torácica/diagnóstico por imagem , Parede Torácica/cirurgia
2.
J Surg Res ; 257: 161-166, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32829000

RESUMO

BACKGROUND: Full-thickness chest wall resection (FTCWR) is an underused modality for treating locally advanced primary or recurrent breast cancer invading the chest wall, for which little data exist regarding morbidity and mortality. We examined the postoperative complication rates in breast cancer patients undergoing FTCWR using a large multinational surgical outcomes database. METHODS: A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. All patients undergoing FTCWR for breast cancer between 2007 and 2016 were identified (n = 137). Primary outcome measures included 30-d postoperative morbidity, composite respiratory complications, and hospital length of stay (LOS). The secondary aim was to compare the postoperative morbidity of FTCWR to those of patients undergoing mastectomy. One-to-one coarsened exact matching was conducted between two groups, which were then compared with respect to morbidity, mortality, reoperations, readmissions, and LOS. RESULTS: The overall rate of postoperative morbidity was 11.7%. Two patients (1.5%) had respiratory complications requiring intubation. Median hospital LOS was 2 d. In the coarsened exact matching analysis, 122 patients were included in each of the two groups. Comparison of matched cohorts demonstrated an overall morbidity for the FTCWR group of 11.5% compared with 8.2% for the mastectomy group (8.2%) (P = 0.52). CONCLUSIONS: FTCWR for the local treatment of breast cancer can be performed with relatively low morbidity and respiratory complications. This is the largest study looking at postoperative complications for FTCWR in the treatment of breast cancer. Future studies are needed to determine the long-term outcomes of FTCWR in this patient population.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/epidemiologia , Parede Torácica/cirurgia , Idoso , Neoplasias da Mama/patologia , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Mastectomia/métodos , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Reoperação/efeitos adversos , Reoperação/métodos , Estudos Retrospectivos , Parede Torácica/patologia , Estados Unidos/epidemiologia
3.
Clin Nucl Med ; 46(1): 76-77, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33065622

RESUMO

F-FDG PET/CT is now an integral part of management of high-grade B-cell lymphoma. It is used for staging, response evaluation, restaging, and surveillance. Although high-grade B-cell lymphoma most commonly presents with involvement of the lymph nodes, spleen, liver, and bone marrow, chest wall involvement is very rare. We present the staging F-FDG PET/CT findings in a case of an 82-year-old woman with double expressor high-grade B-cell lymphoma of isolated presternal anterior chest wall mass.


Assuntos
Fluordesoxiglucose F18 , Linfoma de Células B/diagnóstico por imagem , Linfoma de Células B/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Parede Torácica/patologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Gradação de Tumores , Estadiamento de Neoplasias , Parede Torácica/diagnóstico por imagem
4.
Anticancer Res ; 40(11): 6505-6511, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109590

RESUMO

BACKGROUND/AIM: This study aimed to investigate the bolus practice among Italian radiation oncologists. PATIENTS AND METHODS: In 2018, a survey on bolus application was sent to all members of the Italian Association of Radiotherapy and Clinical Oncology. RESULTS: The survey was joined by 102 radiation oncologists. Not all respondents answered to every question. A 69.5% of 82 respondents used bolus in case of skin infiltration and 52 of 68 respondents (76.5%) applied it every day. Skin was included as part of chest wall Clinical Target Volume both in the absence or the presence of breast reconstruction. Five mm bolus was the most used. 3D Conformal radiotherapy was the most used technique, in 73.5% of cases. Acute RTOG G2-G3 skin toxicity was recorded by 93.9% physicians. CONCLUSION: There was heterogeneity in the use of bolus, though an agreement was found in some topics. The achievement of a National Consensus may represent an interesting future goal.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/radioterapia , Radioterapia Adjuvante/métodos , Pele/efeitos da radiação , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Terapia Combinada , Relação Dose-Resposta à Radiação , Feminino , Humanos , Itália/epidemiologia , Mamoplastia , Mastectomia , Oncologia/tendências , Pessoa de Meia-Idade , Padrões de Prática Médica , Radio-Oncologistas , Radioterapia Conformacional , Pele/patologia , Parede Torácica/patologia , Parede Torácica/efeitos da radiação
5.
Medicine (Baltimore) ; 99(35): e21935, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871936

RESUMO

RATIONALE: Follicular dendritic cell sarcoma (FDCS) is a rare malignant tumor that originates from germinal center follicular dendritic cells, and can occur at both nodal and extranodal sites. There are very few described cases of FDCS arising in the chest wall. PATIENT CONCERNS: A 44-year-old male patient presented with a history of right chest wall pain for 5 months. DIAGNOSES: Positron emission tomography/computed tomography showed a significant increase in F-fluorodeoxyglucose uptake and multiple small axillary lymph nodes without hypermetabolic lesions. Immunohistochemistry results of a core-needle biopsy indicated FDCS, which was consistent with the postoperative pathological examination. INTERVENTIONS: The patient underwent tumor resection with lymphadenectomy of level I axillary nodes. No metastasis in the lymph nodes was observed in the postoperative pathological examination. The patient did not accept chemotherapy or radiotherapy. OUTCOMES: After 18 months, the patient remains in good condition with no evidence of disease recurrence. LESSONS: This report highlights a rare case of a FDCS arising in the chest wall. Accurate clinical diagnosis and staging of this rare malignant sarcoma is essential for the developmnt of effective treatment strategies. Preoperative F-fluorodeoxyglucose positron emission tomography/computed tomography scanning combined with core-needle biopsy could provide differentiation between benign and malignant tumors, as well as lymph node involvement and metastatic status.


Assuntos
Sarcoma de Células Dendríticas Foliculares/diagnóstico , Neoplasias Torácicas/diagnóstico , Parede Torácica , Adulto , Biópsia com Agulha de Grande Calibre , Dor no Peito/etiologia , Sarcoma de Células Dendríticas Foliculares/patologia , Sarcoma de Células Dendríticas Foliculares/cirurgia , Fluordesoxiglucose F18 , Humanos , Imuno-Histoquímica , Excisão de Linfonodo , Linfonodos/patologia , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Torácicas/patologia , Neoplasias Torácicas/cirurgia , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Parede Torácica/cirurgia
6.
PLoS One ; 15(9): e0238539, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941460

RESUMO

PURPOSE: To compare the effectiveness between parallel bar and cross-bar techniques for treating pectus excavatum. METHODS: A total of 80 patients who underwent parallel bar insertion (group 1) or cross-bar insertion (group 2) were evaluated retrospectively. From the pre- and post-operative chest CT images, vertebral-level-specific pectus indices were defined as the ratio of the maximum transverse diameter to the anteroposterior diameter of the thoracic cavity at a specific vertebral level and measured at 3 levels up (3Up-PI, 2Up-PI, 1Up-PI) and 1 vertebral level down (1Down-PI) from the narrowest point. The effectiveness of double-bar correction was compared between the 2 groups using postoperative vertebral level-specific pectus index changes. RESULTS: A total of 44 patients were enrolled in group 1, and 36 patients were enrolled in group 2. Preoperative pectus index values were not different between the 2 groups (4.5 ± 1.0 vs. 4.9 ± 1.5, P = 0.135). After double-bar correction, pectus index significantly decreased in both groups. There were no differences in postoperative pectus indices between the 2 groups (2.7 ± 0.4 vs. 2.6 ± 0.3, P = 0.197). Postoperative changes in 3Up-PI, 2Up-PI, and 1Up-PI were not significantly different between the 2 groups (P > 0.05). However, postoperative changes at the narrowest level and at 1Down-PI were significantly greater in group 2 than in group 1 (1.78 ± 0.85 vs. 2.32 ± 1.44, P = 0.009; 1.21 ± 0.70 vs. 1.70 ± 1.20, P = 0.009, respectively). CONCLUSIONS: Double-bar correction appears to be effective for treating pectus excavatum. The cross-bar insertion technique might be superior to the parallel bar insertion technique for correcting a wider range of deformities, especially at the lower part of the depression.


Assuntos
Tórax em Funil/cirurgia , Adolescente , Adulto , Feminino , Tórax em Funil/patologia , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Esterno/anormalidades , Esterno/patologia , Esterno/cirurgia , Parede Torácica/patologia , Parede Torácica/cirurgia , Resultado do Tratamento , Adulto Jovem
7.
Medicine (Baltimore) ; 99(34): e21726, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846792

RESUMO

RATIONALE: The most common critical incidents in pediatric anesthesia are perioperative respiratory adverse events (PRAE), which occur more often in neonates and account for one-third of anaesthesia-related cardiac arrests. It is crucial to maintain an open stable airway during anesthesia in neonates, as this population has a low oxygen reserve, small airways, and the loss of protective airway reflexes under general anesthesia. PATIENT CONCERNS: A 6-day-old premature newborn underwent minimally invasive sclerotherapy under general anesthesia. For high-risk premature neonates, the selections of the anesthesia and airway device are extremely important, as those factors directly affect the prognosis. DIAGNOSES: B ultrasound and computed tomography (CT) revealed a large mass from the left chest wall to axilla, which was suspected to be a lymphocele. INTERVENTIONS: Minimally invasive sclerotherapy was performed under inhalation anesthesia. After the initiation of anesthesia, a laryngeal mask was placed to control airway. Anesthesia was maintained intraoperatively via sevoflurane inhalation with spontaneous breathing. No accidental displacements or PRAE occurred. OUTCOME: The operation and anesthesia process was stable and safe. The patient discharged at 2 days postoperatively. LESSONS: Minimally invasive sclerotherapy in a premature neonate is an operation with an extremely short operation time and minimal trauma, but a very high anesthesia risk and risk of PRAE. Anesthesia management is very important in a premature neonate undergoing a very short surgery under general anesthesia. Total sevoflurane inhalation general anesthesia and laryngeal mask airway control with spontaneous breathing may be an ideal option to reduce PRAE during very short surgery in a premature neonate.


Assuntos
Anestesia Geral/métodos , Recém-Nascido Prematuro , Linfocele/cirurgia , Escleroterapia/métodos , Parede Torácica/cirurgia , Humanos , Recém-Nascido , Parede Torácica/patologia
8.
J Pediatr Orthop ; 40(4): 183-189, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32132448

RESUMO

BACKGROUND: Over the past 100 years, many procedures have been developed for correcting restrictive thoracic deformities which cause thoracic insufficiency syndrome. However, none of them have been assessed by a robust metric incorporating thoracic dynamics. In this paper, we investigate the relationship between radiographic spinal curve and lung volumes derived from thoracic dynamic magnetic resonance imaging (dMRI). Our central hypothesis is that different anteroposterior major spinal curve types induce different restrictions on the left and right lungs and their dynamics. METHODS: Retrospectively, we included 25 consecutive patients with thoracic insufficiency syndrome (14 neuromuscular, 7 congenital, 4 other) who underwent vertical expandable prosthetic titanium rib surgery and received preimplantation and postimplantation thoracic dMRI for clinical care. We measured thoracic and lumbar major curves by the Cobb measurement method from anteroposterior radiographs and classified the curves as per Scoliosis Research Society (SRS)-defined curve types. From 4D dMRI images, we derived static volumes and tidal volumes of left and right lung, along with left and right chest wall and left and right diaphragm tidal volumes (excursions), and analyzed their association with curve type and major curve angles. RESULTS: Thoracic and lumbar major curve angles ranged from 0 to 136 and 0 to 116 degrees, respectively. A dramatic postoperative increase in chest wall and diaphragmatic excursion was seen qualitatively. All components of volume increased postoperatively by up to 533%, with a mean of 70%. As the major curve, main thoracic curve (MTC) was associated with higher tidal volumes (effect size range: 0.7 to 1.0) than thoracolumbar curve (TLC) in preoperative and postoperative situation. Neither MTC nor TLC showed any meaningful correlation between volumes and major curve angles preoperatively or postoperatively. Moderate correlations (0.65) were observed for specific conditions like volumes at end-inspiration or end-expiration. CONCLUSIONS: The relationships between component tidal volumes and the spinal curve type are complex and are beyond intuitive reasoning and guessing. TLC has a much greater influence on restricting chest wall and diaphragm tidal volumes than MTC. Major curve angles are not indicative of passive resting volumes or tidal volumes. LEVEL OF EVIDENCE: Level II-diagnostic.


Assuntos
Imagem por Ressonância Magnética/métodos , Implantação de Prótese , Insuficiência Respiratória , Costelas/cirurgia , Escoliose , Doenças Torácicas , Adolescente , Criança , Feminino , Humanos , Masculino , Equipamentos Ortopédicos , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/prevenção & controle , Estudos Retrospectivos , Escoliose/complicações , Escoliose/diagnóstico , Escoliose/fisiopatologia , Escoliose/cirurgia , Doenças Torácicas/diagnóstico , Doenças Torácicas/etiologia , Doenças Torácicas/fisiopatologia , Doenças Torácicas/cirurgia , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Resultado do Tratamento
9.
Anticancer Res ; 40(3): 1519-1526, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132052

RESUMO

BACKGROUND/AIM: Chondrosarcomas (CS) of the chest wall are rare, but present an aggressive biological behavior compared to CS of the extremities. The aims of the present study were to determine factors associated with oncological outcomes as well as complications. PATIENTS AND METHODS: We retrospectively analyzed 53 patients (42 primary, 11 recurrent tumors). In total, 39 central CS, 10 peripheral CS, 3 dedifferentiated CS and 1 mesenchymal CS were included. The ribs were most commonly affected (68%). Overall survival and disease-free survival were estimated with Kaplan-Meier analyses and compared with log-rank test. RESULTS: Mean follow-up was 7 years. Negative margins were achieved in 87% of patients. Thirty patients (57%) remained continuously disease-free (NED), three (5%) NED after treatment of relapse, seven (13%) were alive with disease, twelve (23%) were dead with disease and one of other cause. The 10-year survival rate was 81% and 45% in primary and recurrent tumors, respectively. Survival was significantly affected by tumor stage (p<0.001), local recurrence (p=0.025) and metastases (p=0.002). Six complications (16%) were observed. CONCLUSION: The outcome is rather poor, especially in patients with local recurrence. Presumably due to a high biological aggressiveness, a stricter definition of surgical margins should be considered for this location.


Assuntos
Condrossarcoma/diagnóstico , Condrossarcoma/cirurgia , Neoplasias Torácicas/diagnóstico , Neoplasias Torácicas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Condrossarcoma/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Torácicas/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Adulto Jovem
11.
J Thorac Cardiovasc Surg ; 159(6): 2512-2520.e1, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32087959

RESUMO

OBJECTIVE: Diffuse chest wall invasion (DCWI) is a common finding in patients undergoing intended resection for malignant pleural mesothelioma. We sought to determine the incidence and preoperative predictors of this finding, and to test our anecdotal impression that contraction of the ipsilateral hemithorax is associated with DCWI. METHODS: This was a single-institution retrospective study of 170 patients undergoing intended macroscopic complete resection for malignant pleural mesothelioma from 2014-2018. A novel metric of thoracic cage volume was calculated by preoperative chest computed tomography. Univariable analyses were performed to determine associations of preoperative variables with DCWI. RESULTS: Macroscopic complete resection was achieved by pleurectomy/decortication in 104 patients (61%) and by extrapleural pneumonectomy in 39 patients (23%). Unresectable disease was discovered at thoracotomy in 27 (16%) of patients; 24 (14%) by DCWI and 3 (2%) by intrathoracic organ invasion. In univariable analysis, decreased ipsilateral thoracic cage volume demonstrated the strongest association with unresectability by DCWI (P = .009) with >5% decrease in thoracic cage volume representing the optimal cutoff (P = .014; area under the curve, 0.67). Other preoperative variables associated with DCWI included preoperative chest pain requiring opioids (P = .028), prior pleurodesis (P = .036), decreased forced vital capacity (P = .023), decreased ipsilateral lung perfusion by ventilation/perfusion lung scan (P = .007), and magnetic resonance imaging findings of chest wall invasion (P = .035). CONCLUSIONS: Preoperative identification of DCWI will avoid unnecessary thoracotomy and accelerate initiation of nonsurgical therapy in malignant pleural mesothelioma. Our data suggest that contraction of thoracic cage volume has merit in predicting malignant pleural mesothelioma unresectability and should be validated in prospective studies.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Mesotelioma/diagnóstico por imagem , Neoplasias Pleurais/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Feminino , Humanos , Imageamento Tridimensional , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Mesotelioma/patologia , Mesotelioma/terapia , Pessoa de Meia-Idade , Invasividade Neoplásica , Seleção de Pacientes , Neoplasias Pleurais/patologia , Neoplasias Pleurais/terapia , Valor Preditivo dos Testes , Estudos Retrospectivos , Parede Torácica/patologia , Parede Torácica/cirurgia , Toracotomia , Procedimentos Desnecessários
13.
Monaldi Arch Chest Dis ; 90(1)2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31970967

RESUMO

Elastofibroma is a rare benign, soft-tissue slow-growing tumor seen predominantly in elderly females. We present such a case in a 46-year-old female. She presented with gradually increasing soft tissue swelling of 8×6 cm in the right inferior subscapular region. MRI showed a large intramuscular lesion with atypia. She underwent excisional biopsy and the histopathology and immunochemistry showed elastofibroma. We present this rare case to emphasize the important role of the diagnostic tools. A definitive diagnosis helps to avoid unnecessary wide and radical resection.


Assuntos
Fibroma/patologia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/cirurgia , Parede Torácica/patologia , Biópsia , Edema/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Neoplasias de Tecidos Moles/metabolismo , Resultado do Tratamento
14.
Medicine (Baltimore) ; 99(4): e18886, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977896

RESUMO

RATIONALE: Giant keloids often have indications for surgical resection, but postoperative reconstruction of the skin and high recurrence of keloids are a challenge for clinical treatment. This article reports a rare successful treatment of a giant keloid in the anterior chest wall by multistage surgery combined with radiotherapy, which is why this case is meaningful. PATIENT CONCERNS: A 66-year-old woman presented a giant keloid with ulcerations and severe itching on the anterior chest wall. She had a history of keloid disease for more than 10 years, and had been treated by multiple operations, with no success. DIAGNOSES: The patient was diagnosed as keloid based on her history and symptoms. Histopathology findings supported our diagnosis. INTERVENTIONS: We successfully excised the keloid after 5 operations and 2 rounds of electron-beam radiotherapy, which was applied at 24 hours after the 4th and 5th operation. OUTCOMES: There was no sign of recurrence over the follow-up period of 24 months. LESSONS: The combination of multistage surgery and radiotherapy presents as a good choice for the treatment of giant keloids.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Queloide/cirurgia , Parede Torácica/cirurgia , Idoso , Feminino , Humanos , Queloide/patologia , Queloide/radioterapia , Período Pós-Operatório , Radioterapia Adjuvante , Pele/patologia , Parede Torácica/patologia
15.
J Vasc Interv Radiol ; 31(2): 294-300, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31899108

RESUMO

PURPOSE: To assess safety and efficacy of percutaneous cryoablation for pain palliation of metastases to pleura and chest wall. MATERIALS AND METHODS: This retrospective single-center cohort study included 22 patients (27% female, mean age 63 y ± 11.4) who underwent 25 cryoablation procedures for pain palliation of 39 symptomatic metastases measuring 5.1 cm ± 1.9 (range, 2.0-8.0 cm) in pleura and chest wall between June 2012 and December 2017. Pain intensity was assessed using a numerical scale (0-10 points). Statistical tests t test, χ2, and Wilcoxon signed rank were performed. RESULTS: Patients were followed for a median of 4.1 months (interquartile range [IQR], 2.3-10.1; range, 0.1-36.7 mo) before death or loss to follow-up. Following cryoablation, pain intensity decreased significantly by a median of 4.5 points (IQR, 2.8-6; range, 0-10 points; P = .0002 points, Wilcoxon signed rank). Pain relief of at least 3 points was documented following 18 of 20 procedures. Pain relief occurred within a median of 1 day following cryoablation (IQR, 1-2; range, 1-4 d) and lasted for a median of 5 weeks (IQR, 3-17; range, 1-34 wk). Systemic opioid requirements decreased in 11 of 22 patients (50%) by an average of 56% ± 34. Difference in morphine milligram equivalents was not significant (P = .73, Wilcoxon signed rank). No procedure-related complications occurred despite previous radiation of 7 tumors. Of 25 procedures, 22 (88%) were performed on an outpatient basis. CONCLUSIONS: Percutaneous cryoablation for metastases to pleura and chest wall can safely provide significant pain relief within days following a single session.


Assuntos
Neoplasias Ósseas/cirurgia , Criocirurgia , Manejo da Dor , Dor/prevenção & controle , Cuidados Paliativos , Neoplasias Pleurais/cirurgia , Parede Torácica/cirurgia , Idoso , Analgésicos Opioides/administração & dosagem , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Criocirurgia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Manejo da Dor/efeitos adversos , Medição da Dor , Neoplasias Pleurais/complicações , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/secundário , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Fatores de Tempo , Resultado do Tratamento
17.
Thorac Cardiovasc Surg ; 68(4): 352-356, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-30736084

RESUMO

OBJECTIVES: Patients undergoing surgery for locally advanced lung cancer involving the chest wall require anatomical lung with extensive en-bloc chest wall resection and appropriate reconstruction.In this proof-of-concept study, we aimed to produce personalized three-dimensional (3D)-printed chest wall prosthesis for a patient undergoing chest wall resection and reconstruction using clinically obtained computed tomography (CT) data. METHODS: Preoperative CT scans of three patients undergoing chest wall resection were analyzed and the areas of resection segmented. This was then used to produce a 3D print of the chest wall and a silicone mold was created from the model. This mold was sterilized and used to produce methyl methacrylate prostheses which were then implanted into the patients. RESULTS: Three patients had their chest wall reconstructed using this technique to produce a patient specific prosthesis. There were no early complications or deaths. CONCLUSIONS: It is possible to use 3D printing to produce a patient specific chest wall reconstruction for patients undergoing chest wall resection for malignancy that is cost-effective. This chest wall is thought to provide stability in the form of prosthetic ribs as well compliance in the form of an expanded polytetrafluoroethylene patch. Further research is required to measure chest wall compliance during the respiratory cycle and long-term follow-up from this method.


Assuntos
Neoplasias da Mama/cirurgia , Neoplasias Pulmonares/cirurgia , Metilmetacrilato , Impressão Tridimensional , Desenho de Prótese , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Torácicos/instrumentação , Parede Torácica/cirurgia , Idoso , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Modelagem Computacional Específica para o Paciente , Estudo de Prova de Conceito , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Thorac Cardiovasc Surg ; 68(4): 341-351, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31394575

RESUMO

BACKGROUND: Anterior chest wall resection for oncological purposes is usually combined with a form of reconstruction. Most surgeons are convinced that ventrally located defects more than 4 to 5 cm require adequate reconstruction to minimize the risk of lung herniation and respiratory distress through paradox motion. We describe our in-house results of ventral chest wall reconstruction using polypropylene mesh without the use of metallic or biological implants regardless of the extent of chest wall resection. METHODS: Patient selection involved ventral chest wall resection and reconstruction by polypropylene mesh for all indications such as primary tumors, metastasis, or infiltration by lung cancer from January 2008 to December 2016. Primary end point was the difference between both sides. Secondary end points were postoperative complications such as infection, surgical revision, and pulmonary complications. RESULTS: Forty-five cases of isolated anterior reconstruction could be identified. In 34 cases, postoperative computed tomography scan of the thorax was available. Fifteen males and 19 females with a median age of 70.5 years were operated. The evaluation of maximum hemithorax diameter between operated and nonoperated sides was documented in centimeters, and the difference was documented in percentage. The mean percentage difference was 11.1% (minimum: 0.3, maximum: 44.4). In one case, wound infection with positive culture could not be treated conservatively and required operative revision and removal of the polypropylene mesh. CONCLUSION: Polypropylene mesh, though not rigid, can safely be used for anterior chest wall reconstruction.


Assuntos
Neoplasias Pulmonares/cirurgia , Polipropilenos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Telas Cirúrgicas , Neoplasias Torácicas/cirurgia , Procedimentos Cirúrgicos Torácicos/instrumentação , Parede Torácica/cirurgia , Idoso , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Invasividade Neoplásica , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/secundário , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Resultado do Tratamento
19.
Gen Thorac Cardiovasc Surg ; 68(3): 298-301, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30903520

RESUMO

The prone position is usually not selected for pulmonary resection. The intraoperative body position is an important issue in surgery for non-small cell lung cancer invading the spine because the standard intraoperative body position for a vertebrectomy is a prone position, while that for a pulmonary resection is a lateral decubitus position. Intraoperative changes in body position can cause several complications. Using an O-arm with a navigation system, a partial vertebrectomy was completed with the patient in a prone position thanks to the recognition of accurate surgical margins in the vertebral body; then, without changing the patient's body position, a lobectomy with systemic lymph node dissection was performed via a posterior approach. Especially for procedures requiring a wide resection of the chest wall, a prone position can be selected for a lobectomy with systemic lymph node dissection via a posterior approach without any significant difficulties.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Posicionamento do Paciente , Neoplasias da Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Neoplasias Pulmonares/diagnóstico por imagem , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Pneumonectomia , Decúbito Ventral , Neoplasias da Coluna Vertebral/secundário , Vértebras Torácicas , Parede Torácica/patologia , Tomografia Computadorizada por Raios X
20.
Autops. Case Rep ; 10(3): e2020166, 2020. graf
Artigo em Inglês | LILACS | ID: biblio-1131826

RESUMO

The chest wall chondrosarcoma (CWC) is a rare slowly growing primary tumor of the chest wall with an incidence of <0.5 per million person-years. We present the case of a giant CWC that caused a mass effect on the mediastinum, heart, and lung. Large tumors with thoracic structures compression may be life threatening, and its resection and subsequent chest wall reconstruction represent a significant multidisciplinary surgical challenge. In this case, despite the large tumor dimensions, the preoperative planning—sparing key reconstructive options without compromising the tumor resection—allowed a complete en bloc tumor excision of a grade III chondrosarcoma with negative histologic margins. Successful reconstruction of the large full-thickness chest wall defect, with a latissimus dorsi muscle flap and methyl methacrylate incorporated into a polypropylene mesh in a sandwich fashion, was accomplished. Patient recovery was uneventful with good functional and aesthetic outcomes, and no evidence of recurrence at 1.5 years follow-up. This case report illustrates the main clinical, radiological, and histologic features of a CWC while discussing the surgical goals and highlighting the principles for chest wall reconstruction following extensive resection of a large and rare entity.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Parede Torácica/patologia , Coração , Pulmão , Mediastino
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