Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.716
Filtrar
1.
J Cardiothorac Surg ; 15(1): 8, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915025

RESUMO

BACKGROUND: Bleeding of the subclavian artery is a fatal condition. Adhesion between the pleura and staple line may develop after surgical treatment of pneumothorax, and collateral arteries often develop from the subclavian artery toward the adhesion at the lung apex; however, atraumatic tearing and bleeding of these collateral arteries into the extrapleural and intrathoracic cavities is rare. CASE PRESENTATION: A 70-year-old man visited the hospital for evaluation of left chest pain. Contrast-enhanced chest computed tomography showed a huge tumor in the left apex of the lung. It was suspected to be an extrapleural huge hematoma, and it ruptured into the thoracic cavity. Bleeding from the left subclavian artery was suspected; therefore, emergency angiography was performed. Angiography showed some collateral circulation from the left subclavian artery to the apex of the left lung. Distal and proximal bleeding points were identified. The distal bleeding point was embolized using coils. The proximal bleeding point was blown out, and stents were placed in the left subclavian artery. He had undergone pneumothorax surgery 20 years previously, and the present bleeding episode was strongly suspected to be associated with that surgery. The collateral circulation from the subclavian artery could have developed because of post-pneumothorax inflammation, eventually rupturing and bleeding into the extrapleural space. CONCLUSIONS: This report described an important case of atraumatic subclavian artery bleeding considered to have been caused by surgical treatment of pneumothorax 20 years previously. Emergency angiography and percutaneous stent placement or coil embolization should be considered first in such cases.


Assuntos
Embolização Terapêutica , Hematoma/etiologia , Hematoma/terapia , Pneumotórax/cirurgia , Artéria Subclávia , Aderências Teciduais/complicações , Idoso , Angiografia , Circulação Colateral , Hematoma/diagnóstico por imagem , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia
2.
Thorac Surg Clin ; 30(1): 15-24, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761280

RESUMO

Nonintubated video-assisted thoracoscopic surgery for the treatment of primary and secondary pneumothorax was first reported in 1997 by Nezu. However, studies on this technique are few. Research in the past 20 years has focused on the perioperative outcomes, including the surgical duration, length of hospital stay, and postoperative morbidity and respiratory complication rates, which appear to be better than those of surgery under intubated general anesthesia. This study provides information pertaining to the physiologic, surgical, and anesthetic aspects and describes the potential benefits of nonintubated thoracoscopic surgery for the management of primary and secondary spontaneous pneumothorax.


Assuntos
Administração dos Cuidados ao Paciente/métodos , Pneumotórax/cirurgia , Complicações Pós-Operatórias , Cirurgia Torácica Vídeoassistida , Anestesia Geral/métodos , Humanos , Pneumotórax/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos
3.
Kyobu Geka ; 72(12): 1038-1041, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701918

RESUMO

The 40-year-old male patient was raced to our hospital complaining respiratory difficulty after hitting his left chest at a handle when falling down from a bicycle. Fracture of 5th left rib and partial lung prolapsed intercostally out of the thorax was observed by computed tomography (CT). Due to exacerbated pneumothorax and pneumoderma recognized 12 hours later by CT with the lung remained incarcerated, a surgery was conducted. Camera port was placed from 8th intercostal part at left midaxillary line. The left lung was partially incarcerated from ruptured intercostal part of fractured 5th rib. Adding a working port from 7th intercostal part at the posterior axillary line, the incarcerated lung was thoracoscopically reduced. The thoracoscopic surgery was completed by fixing the rib outside the thoracic wall with 2-0 nylon suture without partial resection of the lung. The patient was discharged on day 7 with satisfactory progress. Thoracoscopic approach is effective for traumatic intercostal lung hernia.


Assuntos
Pneumotórax , Cirurgia Torácica Vídeoassistida , Adulto , Hérnia , Herniorrafia , Humanos , Pulmão , Masculino , Pneumotórax/cirurgia , Tomografia Computadorizada por Raios X
4.
Scand J Trauma Resusc Emerg Med ; 27(1): 90, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604472

RESUMO

BACKGROUND: For neonates and children requiring decompression of tension pneumothorax, specific recommendations for the choice of needle type and size are missing. The aim of this retrospective study was to determine optimal length and diameter of needles for decompression of tension pneumothorax in paediatric patients. METHODS: Utilizing computed tomography, we determined optimal length and diameter of needles to enable successful decompression and at the same time minimize risk of injury to intrathoracic structures and the intercostal vessels and nerve. Preexisting computed tomography scans of the chest were reviewed in children aged 0, 5 and 10 years. Chest wall thickness and width of the intercostal space were measured at the 4th intercostal space at the anterior axillary line (AAL) on both sides of the thorax. In each age group, three needles different in bore and length were evaluated regarding sufficient length for decompression and risk of injury to intrathoracic organs and the intercostal vessels and nerve. RESULTS: 197 CT-scans were reviewed, of which 58 were excluded, resulting in a study population of 139 children and 278 measurements. Width of the intercostal space was small at 4th ICS AAL (0 years: 0.44 ± 0.13 cm; 5 years: 0.78 ± 0.22 cm; 10 years: 1.12 ± 0.36 cm). The ratio of decompression failure to risk of injury at 4th ICS AAL was most favourable for a 22G/2.5 cm catheter in infants (Decompression failure: right: 2%, left: 4%, Risk of injury: right: 14%, left: 24%), a 22G/2.5 cm or a 20G/3.2 cm catheter in 5-year-old children (20G/3.2 cm: Decompression failure: right: 2.1%, left: 0%, Risk of injury: right: 2.1%, left: 17%) and a 18G/4.5 cm needle in 10-year-old children (Decompression failure: right: 9.5%, left: 9.5%, Risk of injury: right: 7.1%, left: 11.9%). CONCLUSIONS: In children aged 0, 5 and 10 years presenting with a tension pneumothorax, we recommend 22G/2.5 cm, 20G/3.2 cm and 18G/4.5 cm needles, respectively, for acute decompression.


Assuntos
Descompressão Cirúrgica/instrumentação , Agulhas , Pneumotórax/diagnóstico por imagem , Pneumotórax/cirurgia , Criança , Pré-Escolar , Tomada de Decisão Clínica , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Costelas/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
Niger J Clin Pract ; 22(9): 1292-1297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489869

RESUMO

Background: Patients who have undergone a lung resection owing to primary spontaneous pneumothorax (PSP) may develop prolonged air leak (PAL) during the postoperative period. The present study investigates potential risk factors associated with postoperative PAL in patients who were operated on for PSP. Materials and Methods: Patients who underwent operations for PSP between January 2004 and November 2017 were investigated retrospectively. Patients who developed postoperative PAL constituted Group 1, and patients without PAL formed Group 2. A comparison of the two groups was made to identify potential risk factors for the development of prolonged air leak. Results: Of the total 79 patients who underwent operations, 18 (22.78%) developed prolonged air leak. All of the patients in Group 1 were male, and the mean age of this group was 23.72 ± 5.76 (18-36) years. Of the patients in Group 2, 51 (83.61%) were male and 10 (16.39%) were female, and the mean age of this group was 25.81 ± 5.91 (17-39) years. There was no statistically significant difference noted between the two groups regarding the investigated factors including age, gender, the total number of previous episodes, number of ipsilateral episodes, number of contralateral episodes, the preferred treatment method for the last episode, smoking status, computerized tomography findings, or the presence of a preoperative air leak. Conclusions: PAL is the most common complication associated with PSP surgeries. Although several factors may affect PAL development, no definite conclusion could be drawn concerning the investigated risk factors. We believe that similar studies may contribute to the care of this rare patient population.


Assuntos
Pneumotórax/etiologia , Complicações Pós-Operatórias/fisiopatologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pneumotórax/cirurgia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Fumar , Cirurgia Torácica Vídeoassistida/métodos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
JSLS ; 23(3)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31427853

RESUMO

Background: Endometriosis is characterized by the presence of endometrial-like glands and stroma outside the uterine cavity and is believed to affect 6%-10% of reproductive-age women. Endometriosis within the lung parenchyma or on the diaphragm and pleural surfaces produces a range of clinical and radiological manifestations. This includes catamenial pneumothorax, hemothorax, hemoptysis, and pulmonary nodules, resulting in an entity known as thoracic endometriosis syndrome (TES). Database: Computerized searches of MEDLINE and PubMed were conducted using the key words "thoracic endometriosis," "catamenial pneumothorax," "catamenial hemothorax," and "catamenial hemoptysis." References from identified sources were manually searched to allow for a thorough review. Conclusion: TES can produce incapacitating symptoms for some patients. Symptoms of TES are nonspecific, so a high degree of clinical suspicion is warranted. Medical management represents the first-line treatment approach. When this fails or is contraindicated, definitive surgical treatment for cases of suspected TES uses a combined video laparoscopy performed by a gynecologic surgeon and video-assisted thoracoscopic surgery performed by a thoracic surgeon. Postoperative hormonal suppression may further reduce disease recurrence.


Assuntos
Endometriose/cirurgia , Hemotórax/cirurgia , Pneumotórax/cirurgia , Doenças Torácicas/cirurgia , Cirurgia Torácica Vídeoassistida , Adulto , Diafragma/cirurgia , Endometriose/diagnóstico , Feminino , Hemotórax/diagnóstico , Humanos , Laparoscopia , Doenças Pleurais/diagnóstico , Doenças Pleurais/cirurgia , Pneumotórax/diagnóstico , Recidiva , Doenças Torácicas/diagnóstico
7.
Kyobu Geka ; 72(6): 481-483, 2019 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-31268026

RESUMO

Pneumothorax induced by Pneumocystis jirovecii( P. jirovecii) pneumonia is often refractory to treatment. A man in his 30's who had malignant lymphoma and received chemotherapy developed P. jirovecii pneumonia. A month after treatment for pneumonia, he developed a secondary pneumothorax. Since drainage was not effective, he underwent right lower lobectomy and bulla resection. Air leakage stopped after surgery but recurred on postoperative day 5. Chest computed tomography showed a new bulla on his right lung. On postoperative day 15, we inserted an endobronchial Watanabe spigot( EWS),and air leakage completely stopped.


Assuntos
Pneumonia por Pneumocystis , Pneumotórax , Adulto , Drenagem , Humanos , Masculino , Pneumonia por Pneumocystis/cirurgia , Pneumotórax/cirurgia , Recidiva , Tomografia Computadorizada por Raios X
10.
Ann Thorac Cardiovasc Surg ; 25(5): 237-245, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31270297

RESUMO

PURPOSE: This study aims to compare the effects and prognosis of medical thoracoscopy-assisted argon plasma coagulation (APC) combined with electrosurgical unit (ESU) surgery, video-assisted thoracic surgery (VATS), and pleurodesis surgery, in providing appropriate treatment for elderly refractory pneumothorax patients. METHODS: Patients with refractory pneumothorax aged over 65 years were divided into three groups: APC combined with ESU (N = 20), VATS (N = 26), and pleurodesis (N = 24). Data on demographic characteristics, lung function evaluation, and short- and long-term prognoses were collected. RESULTS: Following surgery, compared with the APC-ESU and pleurodesis groups, patients in the VATS group demonstrated poor short-term prognoses, with high pleural effusion drainage levels and high visual analog scores (VAS; P <0.05). After the surgery, St. George's Respiratory Questionnaire (SGRQ) scores in the pleurodesis group were slightly elevated, whereas SGRQ scores in both the APC-ESU and VATS groups demonstrated a continual decrease. Finally, medical resource consumption analysis demonstrated a significant difference in hospitalization costs among the three groups; the VATS group being the most expensive. CONCLUSION: Medical thoracoscopy-assisted APC combined with ESU is a safe, effective, and affordable treatment for elderly patients with refractory pneumothorax.


Assuntos
Coagulação com Plasma de Argônio/instrumentação , Eletrocirurgia/instrumentação , Pleurodese , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida , Toracoscopia/instrumentação , Idoso , Idoso de 80 Anos ou mais , Coagulação com Plasma de Argônio/efeitos adversos , Coagulação com Plasma de Argônio/economia , Análise Custo-Benefício , Eletrocirurgia/efeitos adversos , Eletrocirurgia/economia , Feminino , Custos Hospitalares , Humanos , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Pleurodese/efeitos adversos , Pneumotórax/diagnóstico por imagem , Pneumotórax/economia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracoscopia/efeitos adversos , Toracoscopia/economia , Fatores de Tempo , Resultado do Tratamento
11.
J Surg Res ; 244: 225-230, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31301478

RESUMO

BACKGROUND: Chest tube (CT) placement is among the most common procedures performed by trauma surgeons; evidence guiding CT management is limited and tends toward thoracic surgery patients. The study goal was to identify current CT management practices among trauma providers. MATERIALS AND METHODS: We designed a Web-based multiple-choice survey to assess CT management practices of trauma providers who were active, senior, or provisional members (n = 1890) of the Eastern Association for the Surgery of Trauma and distributed via e-mail. Descriptive statistics were used. RESULTS: The response rate was 39% (n = 734). Ninety-one percent of respondents were attending surgeons, the remainder fellows or residents. Regarding experience, 36% of respondents had five or fewer years of practice, 54% 10 y or fewer, and 79% 20 y or fewer. Attendings were more likely than trainees to place pigtail catheters for stable patients with pneumothorax (PTX). Attendings with experience of <5 y were more likely to choose a pigtail than more experienced surgeons for elderly patients with PTX. Respondents preferred standard size CTs for hemothorax and unstable patients with PTX, and larger tubes for unstable patients with hemothorax. Most respondents (53%) perceived the quality of evidence for trauma CT management to be low and cited personal experience and training as the main factors driving their practice. CONCLUSIONS: Trauma CT management is variable and nonstandardized, depending mostly on clinician training and personal experience. Few surgeons identify their practice as evidence based. We offer compelling justification for the need for trauma CT management research to determine best practices.


Assuntos
Tubos Torácicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Toracostomia/instrumentação , Ferimentos e Lesões/cirurgia , Adulto , Fatores Etários , Idoso , Competência Clínica/estatística & dados numéricos , Hemotórax/etiologia , Hemotórax/cirurgia , Humanos , Pneumotórax/etiologia , Pneumotórax/cirurgia , Padrões de Prática Médica/normas , Inquéritos e Questionários/estatística & dados numéricos , Toracostomia/normas , Toracostomia/estatística & dados numéricos , Ferimentos e Lesões/complicações
12.
J Craniofac Surg ; 30(8): e760-e763, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31348198

RESUMO

The purpose of this study is to evaluate the frequency of pneumothorax following orthognathic surgery and describe its clinical presentation. A retrospective analysis of a hospital database was carried out on consecutive patients with normal presurgical clinical assessment, laboratory findings, and chest X-ray who underwent orthognathic surgery from January 2007 to September 2018 in the Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Two patients (0.038%), 1 male (age 20 years) and 1 female (age 32 years), complained of respiratory difficulty and chest pain and were clearly diagnosed with postoperative pneumothorax by radiographic chest X-rays from a sample of 5229 consecutive patients during the study period. Intercostal drainage under local anesthesia was performed immediately and the treatment effects for both patients were satisfactory. The present study findings indicate that although orthognathic surgeries can be safely performed in patients with craniofacial anomalies, some unexpected complications such as pneumothorax may occur. Therefore, accurate postoperative follow-up must be done in every patient to monitor possible clinical complications. Patients who experience respiratory difficulty and postoperative chest pain may have pneumothorax, and once it is diagnosed, treatment should be promptly carried out to eliminate further severe sequelae.


Assuntos
Cirurgia Ortognática , Pneumotórax/cirurgia , Adulto , Anestesia Local/efeitos adversos , Feminino , Humanos , Doença Iatrogênica , Incidência , Masculino , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Procedimentos Ortopédicos/efeitos adversos , Dor Pós-Operatória , Pneumotórax/diagnóstico por imagem , Pneumotórax/epidemiologia , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Adulto Jovem
13.
Acta Vet Scand ; 61(1): 37, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349870

RESUMO

BACKGROUND: Pulmonary hypoplasia (PH) and congenital lobar emphysema (CLE) are very rare congenital pulmonary anomalies in veterinary medicine. PH refers to the incomplete pulmonary development due to embryologic imbalance of bronchial development between the lung buds, while CLE is defined as alveolar hyperinflation due to bronchial collapse during expiration caused by bronchial cartilage dysplasia, external bronchial compression, and idiopathic etiology. CLE may develop into pulmonary blebs or bullae that may rupture and induce a spontaneous pneumothorax. There are no reports on concurrent PH and CLE in animals. CASE PRESENTATION: A 7-month-old castrated male Italian Greyhound weighing 5.5 kg presented with vomiting and acute onset of severe dyspnea without any previous history of disease. After emergency treatment including oxygen supplementation and thoracocentesis, plain radiology and computed tomography scanning were performed and lobar emphysema with multiple bullae in the left cranial lung lobe associated with tension pneumothorax was identified. Since the pneumothorax was not resolved despite continuous suction of intrathoracic air for 3 days, a complete lobectomy of the left cranial lung lobe was performed. The excised lobe was not grossly divided into cranial and caudal parts, but a tissue mass less than 1 cm in size was present at the hilum and cranial to the excised lobe. Postoperatively, the dog recovered rapidly without air retention in the thoracic cavity. Histopathologically, the mass was identified as a hypoplastic lung tissue with collapsed alveoli, bronchial dysplasia, and pulmonary arterial hypertrophy. Additionally, the excised lung lobe presented CLE with marked ectasia of alveoli, various blebs and bullae, and general bronchial cartilage dysplasia. According to gross and histopathologic findings, the dog was diagnosed with concurrent PH and CLE in the left cranial lung lobe. During 16 months of follow-up, the dog was well and without any respiratory problems. CONCLUSIONS: This case report confirmed the clinical and histologic features of two different types of rare congenital pulmonary anomalies, PH and CLE, which occurred concurrently in a single lung lobe of a young dog. The condition was successfully managed with lobectomy.


Assuntos
Anormalidades Múltiplas/veterinária , Doenças do Cão/congênito , Pneumopatias/veterinária , Pulmão/anormalidades , Pneumotórax/veterinária , Enfisema Pulmonar/congênito , Animais , Cães , Pulmão/química , Pulmão/patologia , Pulmão/cirurgia , Pneumopatias/congênito , Masculino , Pneumotórax/etiologia , Pneumotórax/patologia , Pneumotórax/cirurgia , Enfisema Pulmonar/complicações , Enfisema Pulmonar/veterinária , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(24): e15888, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192921

RESUMO

RATIONALE: Suppression and of cancer metastasis is one of the most important issues in cancer care. Considering the typical clinical course of metastases, cancer cells might prefer certain environments or conditions. However, favorable environments for cancer metastasis have not been clearly identified. We had previously described a case of dual, yet separate, pancreatic and colon cancer, in which the metastatic pancreatic cancer was localized at the invasive portion of the colon cancer. We hypothesized that metastatic pancreatic cancer took over the colon cancer microenvironment. PATIENT CONCERNS: We experienced an another case of double cancer in a 65-year-old man who had lung squamous cell carcinoma and an independent pancreatic adenocarcinoma that metastasized to the liver as well as to the lung cancer lesion and pulmonary fibrotic regions associated with pneumothorax and bronchiolization. INTERVENTIONS: The pneumothorax could not be controlled by conservative treatment. Thus, an emergency surgery with partial resection of the lower lobe of right lung was performed. DIAGNOSES: We found multiple pancreatic cancer metastases in the lung cancer and fibrotic lesions in the surgical specimen. However, we detected no metastasis in normal lung tissues except inside small arteries, although the lung cancer and fibrotic tissue areas were smaller than the normal lung tissue areas in the surgical specimen. OUTCOMES: The patient died 50 days after the surgery. LESSONS: This case may thus provide evidence to strengthen our hypothesis that pancreatic cancer prefers to metastasize to other independent cancer lesions, overtaking the cancer microenvironment constructed by other independent cancers. The lung cancer microenvironment, rich in myofibroblasts and/or cancer-associated fibroblasts, might be suitable for pancreatic carcinoma metastasis. In addition, we propose the hypothesis that compared with normal tissues, noncancerous fibrotic lesions are preferable destinations for cancer metastasis. Furthermore, metastasis of pancreatic carcinoma to lung cancer and fibrotic tissues might be more common, although such cases have not been previously reported.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Pulmonares/cirurgia , Segunda Neoplasia Primária/cirurgia , Neoplasias Pancreáticas/cirurgia , Pneumotórax/cirurgia , Idoso , Carcinoma de Células Escamosas/diagnóstico , Evolução Fatal , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Masculino , Segunda Neoplasia Primária/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Fibrose Pulmonar/diagnóstico , Fibrose Pulmonar/cirurgia , Microambiente Tumoral
16.
J Surg Res ; 243: 206-212, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31195349

RESUMO

BACKGROUND: Giant pulmonary bullae (GPB) is rare. The aim of this study was to evaluate the functional results of video-assisted thoracic surgery (VATS) in the treatment of GPB and the factors associated with complications following VATS resection for GPB. MATERIALS AND METHODS: From January 2010 to January 2015, 44 GPB patients underwent surgery with VATS. Individual GPB patient characteristics and surgical outcomes were evaluated. The patients were separated into two groups (an emphysematous group and a nonemphysematous group), and differences between the respective groups were investigated. RESULTS: Although there were no mortalities within a 30-d postoperative period among the 44 GPB patients treated surgically with VATS, 28 experienced postoperative complications, of which the most common were air leaks. VATS for GPB resulted in obvious improvements in symptoms and lung function in the majority of cases. Among 26 patients with preoperative dyspnea, the symptoms of 22 patients (84.62%) improved after treatment with VATS resection for GPB, and the mean forced expiratory volume in 1 s increased from 2.24 L preoperatively to 2.5 L postoperatively (P = 0.02). The complication rate of patients aged >48 y, who smoked and had emphysema, was significantly higher than that of those who did not smoke and did not have emphysema (79.2% versus 45%, P = 0.019; 85.7% versus 25%, P < 0.05; 88% versus 31.6%, P < 0.05). These characteristics could be associated with complications. CONCLUSIONS: VATS resection is a safe and effective treatment for GPB and leads to improvements in symptoms and lung function. Patients >48 y, who smoked and had emphysema, were more likely to experience postoperative complications. There could be a relationship between these characteristics and the patients' postoperative complications.


Assuntos
Vesícula/complicações , Pneumotórax/cirurgia , Complicações Pós-Operatórias/epidemiologia , Cirurgia Torácica Vídeoassistida , Adolescente , Adulto , Idoso , Vesícula/cirurgia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfisema Pulmonar/complicações , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
17.
BMC Surg ; 19(1): 46, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035996

RESUMO

BACKGROUND: The transthoracic thoracoscopic surgery is currently accepted as a favorable technique for bullectomy for primary spontaneous pneumothorax. Recently, uniportal subxiphoid thoracoscopic surgery has been proposed as an alternative to conventional transthoracic thoracoscopic surgery. METHODS: From November 2014 and January 2016, 127 consecutive patients who met the inclusion criteria were enrolled in this study. Among these patients, 32 were treated using subxipoid approach, whereas 95 were treated using transthoracic approach. Propensity score case-matching was performed to adjust for patient backgrounds. RESULTS: The two groups of 32 pairs were well matched for baseline and surgical characteristics. Patients who underwent subxipoid approach had a longer operation time than transthoracic approach (p = 0.004). The subgroup analysis showed that the operation time for bilateral bullectomy was similar between the groups (p = 0.986). There were no differences between the groups with respect to the hospital stay after surgery, chest drain duration, the number of the staples used for the operation, and postoperative recurrence. However, the provoked arrhythmias events during surgery were significantly higher in the subxiphoid approach group (p = 0.011). CONCLUSIONS: Although transthoracic thoracoscopic surgery for spontaneous pneumothorax is well established, uniportal subxiphoid thoracoscopic surgery may be a potentially alternative way to management of patients with spontaneous pneumothorax in selected cases, especially for bilateral surgery, but causions should be taked.


Assuntos
Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Toracoscopia/métodos , Adolescente , Adulto , Arritmias Cardíacas/etiologia , Drenagem , Feminino , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Pontuação de Propensão , Recidiva , Grampeamento Cirúrgico , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracoscopia/efeitos adversos , Adulto Jovem
18.
Int J Surg Pathol ; 27(6): 593-597, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31068050

RESUMO

The histology in cases of primary spontaneous pneumothorax is generally nonspecific, but a careful examination, taking into account clinical data, may reveal subtle tissue alterations leading to a specific diagnosis in cases that might otherwise be taken as primary and spontaneous. In this article, we describe 3 cases of catamenial pneumothorax histologically demonstrated by the presence of scattered and submillimeter aggregates of bland-looking spindle endometrial stromal cells (so-called "stromal endometriosis") into the visceral pleural layer. The use of CD10 and estrogen and progesterone receptors in lung resection specimens from young women experiencing recurrent pneumothorax is extremely helpful in disclosing endometriosis and confirming a diagnosis of catamenial pneumothorax. A review of the literature on this topic is also presented.


Assuntos
Pulmão/patologia , Neprilisina/análise , Pneumotórax/diagnóstico , Receptores Estrogênicos/análise , Receptores de Progesterona/análise , Adulto , Biomarcadores/análise , Biópsia , Feminino , Humanos , Pulmão/cirurgia , Pneumotórax/patologia , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida
19.
Radiol Med ; 124(9): 833-837, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31134432

RESUMO

OBJECTIVES: Chest computed tomography is commonly used in patients with primary spontaneous pneumothorax to detect the presence of pulmonary blebs or bullae. The aim of this study is to calculate the accuracy of chest computed tomography to detect surgically resectable blebs or bullae in patients with primary spontaneous pneumothorax. METHODS: This is a retrospective study includes all patients with primary spontaneous pneumothorax who underwent chest computed tomography evaluation for their disease over the period from January 2005 to December 2015. Patients who underwent surgical exploration were sub-grouped to calculate the sensitivity and the specificity of the chest computed tomography to detect surgically resectable pulmonary blebs or bullae. RESULTS: A total of 143 patients were included in the study. Among them, 120 patients underwent surgical exploration with the finding of 95.7% sensitivity and 42.3% specificity for the chest computed tomography in detection of surgically resectable pulmonary blebs or bullae. CONCLUSION: The sensitivity of the chest computed tomography scan is high in detecting surgically resectable pulmonary blebs or bullae. However, the specificity is low. This may lead to overdiagnosis of the patients to have pulmonary blebs and bullae. Therefore, the routine use of chest computed tomography scan before the surgical exploration in patients with primary spontaneous pneumothorax should depend on the clinical judgment.


Assuntos
Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Vesícula/diagnóstico por imagem , Vesícula/etiologia , Vesícula/cirurgia , Feminino , Humanos , Masculino , Pneumotórax/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
20.
Medicine (Baltimore) ; 98(20): e15661, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096495

RESUMO

RATIONALE: At present, data regarding refractory pneumothorax treated with video-assisted thoracic surgery (VATS) in combination with extracorporeal membrane oxygenation (ECMO) in critically ill patients with H7N9 pneumonia have never been reported. PATIENT CONCERNS: A laboratory-confirmed case of human infection with avian influenza A (H7N9) virus was treated in our hospital. Acute respiratory distress syndrome (ARDS) developed and the patient was oxygenated via veno-venous ECMO due to the failure of mechanical ventilation. Unfortunately, a right refractory pneumothorax occurred. Despite treatment with pleural drainage and select bronchial occlusion, the patient still failed to improve. DIAGNOSIS: Fatal H7N9 pneumonia complicated with severe ARDS, pulmonary bullae, and refractory pneumothorax. INTERVENTIONS: Successful combination of ECMO with VATS of pulmonary bullae resection was performed and pneumothorax was cured. OUTCOMES: One week after the operation, ECMO was removed. However, the patient finally developed multiorgan failure (MOF) complicated by refractory hypoxemia due to progressive lung fibrosis and died 36 days after admission. LESSONS: Although the patient died of MOF triggered by severe lung fibrosis at last, the successful treatment of refractory pneumothorax by combination of ECMO with VATS is encouraging. Thus, when refractory pneumothorax in a patient with severe pulmonary dysfunction fails to improve through routine therapy, the treatment of pneumothorax by VATS based on ECMO support can be considered as a feasible selection.


Assuntos
Vesícula/complicações , Estado Terminal , Oxigenação por Membrana Extracorpórea/métodos , Pneumonia Viral/complicações , Pneumotórax/complicações , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Vesícula/cirurgia , Humanos , Subtipo H7N9 do Vírus da Influenza A , Masculino , Síndrome do Desconforto Respiratório do Adulto/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA