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1.
Respir Res ; 21(1): 236, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938445

RESUMO

BACKGROUND: Spontaneous pneumothorax is an uncommon complication of COVID-19 viral pneumonia. The exact incidence and risk factors are still unknown. Herein we review the incidence and outcomes of pneumothorax in over 3000 patients admitted to our institution for suspected COVID-19 pneumonia. METHODS: We performed a retrospective review of COVID-19 cases admitted to our hospital. Patients who were diagnosed with a spontaneous pneumothorax were identified to calculate the incidence of this event. Their clinical characteristics were thoroughly documented. Data regarding their clinical outcomes were gathered. Each case was presented as a brief synopsis. RESULTS: Three thousand three hundred sixty-eight patients were admitted to our institution between March 1st, 2020 and June 8th, 2020 for suspected COVID 19 pneumonia, 902 patients were nasopharyngeal swab positive. Six cases of COVID-19 patients who developed spontaneous pneumothorax were identified (0.66%). Their baseline imaging showed diffuse bilateral ground-glass opacities and consolidations, mostly in the posterior and peripheral lung regions. 4/6 cases were associated with mechanical ventilation. All patients required placement of a chest tube. In all cases, mortality (66.6%) was not directly related to the pneumothorax. CONCLUSION: Spontaneous pneumothorax is a rare complication of COVID-19 viral pneumonia and may occur in the absence of mechanical ventilation. Clinicians should be vigilant about the diagnosis and treatment of this complication.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pneumotórax/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/patogenicidade , Causas de Morte , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Evolução Fatal , Feminino , Interações Hospedeiro-Patógeno , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Philadelphia/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Pneumotórax/diagnóstico , Pneumotórax/terapia , Pneumotórax/virologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
2.
Clin Imaging ; 67: 207-213, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32871424

RESUMO

PURPOSE: We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. MATERIALS AND METHODS: A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. RESULTS: Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. CONCLUSION: SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.


Assuntos
Infecções por Coronavirus/complicações , Enfisema Mediastínico/etiologia , Pneumonia Viral/complicações , Enfisema Subcutâneo/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Comorbidade , Infecções por Coronavirus/virologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hospitalização , Humanos , Masculino , Enfisema Mediastínico/epidemiologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Respiração Artificial/efeitos adversos , Enfisema Subcutâneo/epidemiologia , Tomografia Computadorizada por Raios X/métodos
3.
Medicine (Baltimore) ; 99(30): e21411, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791756

RESUMO

Lung cancer is a common malignancy worldwide, and risk factors include bronchitis, asthma, tuberculosis, smoking, and air pollution. These are also risk factors for spontaneous pneumothorax, a benign disease. We hypothesized that patients who experience a spontaneous pneumothorax have a greater risk to develop lung cancer, and designed a study to determine if this is so.We used the population-based Taiwan Health Insurance Research Database to perform a retrospective cohort study. The database includes more than 99% of the population of Taiwan. We established a 27,405-person pneumothorax cohort and a 109,620 person comparison cohort with data from 2000 to 2009 to evaluate the relationship between spontaneous pneumothorax and lung cancer.Multivariable analysis showed that patients who have had a spontaneous pneumothorax have a greater relative risk to develop lung cancer. The overall hazard ratio was 2.09 (95% confidence interval 1.69-2.58) adjusted by age, gender, hypertension, diabetes mellitus, and chronic lung diseases such as chronic obstructive pulmonary disease, tuberculosis, asthma, bronchitis, and emphysema. A dose effect was present; a high frequency of spontaneous pneumothorax was associated with a greater relative risk to develop lung cancer. If the spontaneous pneumothorax frequency was greater than 2 times per year, the hazard ratio was 34.09 (95% confidence interval 22.74-51.10)Patients with spontaneous pneumothorax have an increased relative risk to develop lung cancer, especially among patients 35 to 49 years of age. The more frequent the occurrence of spontaneous pneumothorax, the greater the relative risk of lung cancer. If the spontaneous pneumothorax frequency was greater than 2 times per year, the increase in risk of lung cancer was more than 30-fold.


Assuntos
Neoplasias Pulmonares/epidemiologia , Pneumotórax/epidemiologia , Adulto , Idoso , Feminino , Humanos , Neoplasias Pulmonares/etiologia , Masculino , Pessoa de Meia-Idade , Pneumotórax/complicações , Estudos Retrospectivos , Taiwan/epidemiologia
4.
PLoS One ; 15(7): e0235624, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634173

RESUMO

BACKGROUND: Spontaneous pneumothorax is a complication that occurs in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD); however, few studies on the clinical implications of pneumothorax for patients with CTD-ILD have been performed. OBJECTIVES: This study aimed to investigate the incidence and prognostic significance of pneumothorax and the risk factors for its onset in patients with CTD-ILD. METHODS: This study included 140 consecutive patients with CTD-ILD. Clinical characteristics, laboratory findings, pulmonary function test results, and chest high-resolution computed tomography (HRCT) images were retrospectively evaluated. RESULTS: A total of 18 patients (12.9%) developed pneumothorax during their clinical course. The cumulative incidence of pneumothorax from the time of CTD-ILD diagnosis was 6.5%, 8.7%, and 11.3% at 1, 3, and 5 years, respectively. The 10-year survival rate was significantly lower in patients with pneumothorax (29.6%) than that in those without pneumothorax (81.3%). The development of pneumothorax was significantly associated with poor prognosis (HR 22.0; p < 0.010). Furthermore, a lower body mass index, greater extent of reticular abnormalities on HRCT, and administration of methylprednisolone pulse therapy were significantly associated with the development of pneumothorax. CONCLUSION: Pneumothorax is a serious complication in the clinical course of patients with CTD-ILD and the onset of pneumothorax predicts a poor outcome.


Assuntos
Doenças do Tecido Conjuntivo/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico , Pneumotórax/diagnóstico , Idoso , Anti-Inflamatórios/uso terapêutico , Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/tratamento farmacológico , Doenças do Tecido Conjuntivo/mortalidade , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/mortalidade , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Pneumotórax/complicações , Pneumotórax/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Testes de Função Respiratória , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Capacidade Vital
5.
Medicine (Baltimore) ; 99(27): e21076, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629740

RESUMO

BACKGROUND AND OBJECTIVE: Undiagnosed pleural effusions (UPEs) are a common problem of respiratory medicine, leading to an increased diagnostic burden globally. However, the most efficient and cost-effective approaches to UPEs remain controversial. This study aimed to assess the diagnostic value of ultrasound-guided needle biopsy (UGNB) in UPEs. METHODS: We conducted a search of PubMed, Embase, the Cochrane Library and reference lists of retrieved studies with no publication data limitation. Articles that investigated the diagnostic accuracy of UGNB in UPEs were included. The quality of eligible studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. The diagnostic value of UGNB was evaluated by calculating the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds rate, and the area under the curve for the summary receiver operating characteristic curve using a random effects model. RESULTS: Seven studies comprising 165 patients with UPEs met the inclusion criteria. UGNB had a pooled sensitivity of 83% (95% confidence intervals [CI], 75% - 89%), a specificity of 100% (95% CI, 90% - 100%), a positive likelihood ratio of 8.89 (95% CI, 3.29 - 24.02), a negative likelihood ratio of 0.23 (95% CI, 0.16 - 0.33), a diagnostic odds rate of 51.47 (95% CI, 14.70 - 180.16), and an area under the curve of 0.94. Six pneumothorax cases (3.6%), 5 local wound infections (3.0%), and 1 empyema case (less than 1%) were observed. There was no significant heterogeneity or publication bias in this study. CONCLUSIONS: Based on current evidence, UGNB is a safe and convenient procedure with a high accuracy for diagnosing UPEs. However, physicians should still be cautious in interpreting negative UGNB results.


Assuntos
Biópsia Guiada por Imagem/instrumentação , Derrame Pleural/patologia , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos , Empiema/epidemiologia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Pneumotórax/epidemiologia , Sensibilidade e Especificidade , Ultrassonografia de Intervenção/efeitos adversos , Infecção dos Ferimentos/epidemiologia , Adulto Jovem
6.
Respir Med ; 168: 105995, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32469710

RESUMO

INTRODUCTION: Brit-Hogg-Dubé syndrome (BHD) is a rare disorder that is estimated to affects about 600 families in the World. The disease-causing mutations is on FLCN gene which codes for folliculin. This protein has a role in different organs as skin, kidney and lung, thanks to the interaction with type I and II cadherins, RhoA activity and the regulation of AMPK, mTORC1 pathways and cell adhesion. The aim of our study is to focus on the manifestation of the syndrome, especially the pulmonary involvement, then on genetical analysis and on the available treatments. MATERIAL AND METHODS: We collected 15 previous studies where we found medical history information, clinical manifestations, radiological and histological diagnosis and genetical analysis. RESULTS: The prevalence of pneumothorax in patients with BHD syndrome was about 65%, but the lung involvement with multiple small cysts, localized especially in the lower part, was 85%. The prevalence of renal involvement in BHD patients ranged from 6.5% to 34%, while skin lesions ranged from 11% to 50%. More than 150 FLCN germline has been described, though the mutation in exon 11 is the most frequently detected, especially among Caucasian population. CONCLUSIONS: BHD syndrome is rare and usually the first manifestations appear in early age. In patients with these clinical and radiological characteristics we suggest taking a careful medical history, though the diagnosis of BHD syndrome should be confirmed with the analysis of FLCN gene.


Assuntos
Síndrome de Birt-Hogg-Dubé/genética , Cistos/etiologia , Pneumopatias/etiologia , Pneumotórax/etiologia , Proteínas Proto-Oncogênicas/genética , Proteínas Supressoras de Tumor/genética , Síndrome de Birt-Hogg-Dubé/complicações , Cistos/epidemiologia , Feminino , Humanos , Pneumopatias/epidemiologia , Masculino , Mutação , Pneumotórax/epidemiologia , Prevalência
7.
Cochrane Database Syst Rev ; 3: CD004953, 2020 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-32187656

RESUMO

BACKGROUND: At birth, infants' lungs are fluid-filled. For newborns to have a successful transition, this fluid must be replaced by air to enable gas exchange. Some infants are judged to have inadequate breathing at birth and are resuscitated with positive pressure ventilation (PPV). Giving prolonged (sustained) inflations at the start of PPV may help clear lung fluid and establish gas volume within the lungs. OBJECTIVES: To assess the benefits and harms of an initial sustained lung inflation (SLI) (> 1 second duration) versus standard inflations (≤ 1 second) in newborn infants receiving resuscitation with intermittent PPV. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 3), MEDLINE via PubMed (1966 to 1 April 2019), Embase (1980 to 1 April 2019), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 1 April 2019). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles to identify randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs comparing initial sustained lung inflation (SLI) versus standard inflations given to infants receiving resuscitation with PPV at birth. DATA COLLECTION AND ANALYSIS: We assessed the methodological quality of included trials using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria (assessing randomisation, blinding, loss to follow-up, and handling of outcome data). We evaluated treatment effects using a fixed-effect model with risk ratio (RR) for categorical data; and mean standard deviation (SD), and weighted mean difference (WMD) for continuous data. We used the GRADE approach to assess the quality of evidence. MAIN RESULTS: Ten trials enrolling 1467 infants met our inclusion criteria. Investigators in nine trials (1458 infants) administered sustained inflation with no chest compressions. Use of sustained inflation had no impact on the primary outcomes of this review: mortality in the delivery room (typical RR 2.66, 95% confidence interval (CI) 0.11 to 63.40 (I² not applicable); typical RD 0.00, 95% CI -0.02 to 0.02; I² = 0%; 5 studies, 479 participants); and mortality during hospitalisation (typical RR 1.09, 95% CI 0.83 to 1.43; I² = 42%; typical RD 0.01, 95% CI -0.02 to 0.04; I² = 24%; 9 studies, 1458 participants). The quality of the evidence was low for death in the delivery room because of limitations in study design and imprecision of estimates (only one death was recorded across studies). For death before discharge the quality was moderate: with longer follow-up there were more deaths (n = 143) but limitations in study design remained. Among secondary outcomes, duration of mechanical ventilation was shorter in the SLI group (mean difference (MD) -5.37 days, 95% CI -6.31 to -4.43; I² = 95%; 5 studies, 524 participants; low-quality evidence). Heterogeneity, statistical significance, and magnitude of effects of this outcome are largely influenced by a single study at high risk of bias: when this study was removed from the analysis, the size of the effect was reduced (MD -1.71 days, 95% CI -3.04 to -0.39; I² = 0%). Results revealed no differences in any of the other secondary outcomes (e.g. risk of endotracheal intubation outside the delivery room by 72 hours of age (typical RR 0.91, 95% CI 0.79 to 1.04; I² = 65%; 5 studies, 811 participants); risk of surfactant administration during hospital admission (typical RR 0.99, 95% CI 0.91 to 1.08; I² = 0%; 9 studies, 1458 participants); risk of chronic lung disease (typical RR 0.99, 95% CI 0.83 to 1.18; I² = 0%; 4 studies, 735 participants); pneumothorax (typical RR 0.89, 95% CI 0.57 to 1.40; I² = 34%; 8 studies, 1377 infants); or risk of patent ductus arteriosus requiring pharmacological treatment (typical RR 0.99, 95% CI 0.87 to 1.12; I² = 48%; 7 studies, 1127 infants). The quality of evidence for these secondary outcomes was moderate (limitations in study design ‒ GRADE) except for pneumothorax (low quality: limitations in study design and imprecision of estimates ‒ GRADE). We could not perform any meta-analysis in the comparison of the use of initial sustained inflation versus standard inflations in newborns receiving resuscitation with chest compressions because we identified only one trial for inclusion (a pilot study of nine preterm infants). AUTHORS' CONCLUSIONS: Our meta-analysis of nine studies shows that sustained lung inflation without chest compression was not better than intermittent ventilation for reducing mortality in the delivery room (low-quality evidence ‒ GRADE) or during hospitalisation (moderate-quality evidence ‒ GRADE), which were the primary outcomes of this review. However, the single largest study, which was well conducted and had the greatest number of enrolled infants, was stopped early for higher mortality rate in the sustained inflation group. When considering secondary outcomes, such as rate of intubation, rate or duration of respiratory support, or bronchopulmonary dysplasia, we found no benefit of sustained inflation over intermittent ventilation (moderate-quality evidence ‒ GRADE). Duration of mechanical ventilation was shortened in the SLI group (low-quality evidence ‒ GRADE); this result should be interpreted cautiously, however, as it might have been influenced by study characteristics other than the intervention. There is no evidence to support the use of sustained inflation based on evidence from our review.


Assuntos
Respiração com Pressão Positiva/métodos , Ressuscitação/métodos , Hemorragia Cerebral Intraventricular/epidemiologia , Permeabilidade do Canal Arterial/tratamento farmacológico , Permeabilidade do Canal Arterial/epidemiologia , Massagem Cardíaca , Mortalidade Hospitalar , Humanos , Recém-Nascido , Intubação Intratraqueal/métodos , Intubação Intratraqueal/mortalidade , Pneumopatias/epidemiologia , Pneumotórax/epidemiologia , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/mortalidade , Surfactantes Pulmonares/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/estatística & dados numéricos , Fatores de Tempo
8.
J Surg Res ; 250: 135-142, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32044510

RESUMO

BACKGROUND: Few studies have analyzed pediatric spontaneous pneumothorax (SPTX) nationally. We sought to better define this patient population and explore the evolution of surgical management. METHODS: Patients (10-20 y old) with an International Classification of Diseases, Ninth Revision diagnosis of SPTX were identified within the Kids' Inpatient Database for the years 2006, 2009, and 2012. Diagnoses and procedures were analyzed by International Classification of Diseases, Ninth Revision codes. National estimates were obtained using case weighting. RESULTS: There were 11,792 pediatric SPTX hospitalizations, and patients were predominantly male (84.0%), non-Hispanic white (69.0%), with a mean age of 17.2 y (95% confidence interval, 17.2-17.3). Overall, 52.5% underwent tube thoracostomy as the primary intervention, and more than one-third had a major surgical procedure (34.9%). From 2006 to 2012, there was an increase in bleb excisions from 81.1% to 86.9% and an increase in mechanical pleurodesis from 64.2% to 69.0%. There was a significant change from a predominantly open thoracotomy approach in 2006 (76.1%) to a video-assisted thoracoscopic approach in 2012 (89.3%). CONCLUSIONS: Pediatric admission for SPTX results in tube thoracostomy in more than half of the cases and surgery in approximately one-third of the cases. Surgical intervention has changed to a more minimally invasive approach during the last decade, and counseling to patients and their families should reflect these updated management strategies. LEVEL OF EVIDENCE: III.


Assuntos
Pleurodese/tendências , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/tendências , Toracostomia/tendências , Adolescente , Fatores Etários , Tubos Torácicos , Criança , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pleurodese/estatística & dados numéricos , Pneumotórax/epidemiologia , Fatores Sexuais , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Toracostomia/instrumentação , Toracostomia/estatística & dados numéricos , Adulto Jovem
9.
Ann Thorac Surg ; 109(4): 1040-1046, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31926158

RESUMO

BACKGROUND: Patients undergoing thoracic lung wedge resection could benefit from tubeless strategies. However, postoperative pneumothorax is a primary limiting factor for such strategies. Accordingly, we evaluated the safety and efficacy of the prophylactic use of an air-extraction catheter as an improved drainage strategy and compared the findings with those for chest tube drainage in patients undergoing thoracic wedge resection. METHODS: Patients undergoing thoracic wedge resection between August 2017 and October 2018 were enrolled in this single-center, randomized, open-label, noninferiority trial. Patients who received an improved drainage strategy involving the use of a prophylactic air-extraction catheter were randomized to the intervention group, whereas those who underwent routine chest tube drainage were assigned to the control group. Analysis was based on the per-protocol population. The primary outcome was the incidence of pneumothorax on postoperative day 1. Secondary outcomes included patient recovery and related complications, including pleural effusion, lung infection, numeric rating scale score for pain, postoperative chest tube or catheter removal, postoperative hospitalization, and chest tube reinsertion. RESULTS: A total of 96 patients were randomized. Baseline demographic and clinical characteristics were similar between groups. The incidence of pneumothorax in the intervention and control groups was 10.0% and 9.1%, respectively (noninferiority, P = 1.00). In addition, there were no significant between-group differences in secondary outcomes. A significantly lower pain score was observed in the intervention group (P = .001). CONCLUSIONS: The improved drainage strategy is not inferior to standard chest tube drainage after thoracic wedge resection and should be popularized.


Assuntos
Drenagem/métodos , Pneumopatias/cirurgia , Pneumonectomia/efeitos adversos , Pneumotórax/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Toracoscopia/efeitos adversos , Adulto , Idoso , Tubos Torácicos , Feminino , Humanos , Incidência , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Pneumotórax/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
10.
Am J Surg ; 219(4): 673-680, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31255258

RESUMO

OBJECTIVES: To assess the impact of short and long term outcomes of diaphragm resection and repair in cyto-reductive surgery (CRS) and intra-peritoneal chemotherapy (IPC). METHODS: 1230 consecutive CRS/IPC procedures were performed between 1996 and 2018 in Sydney, Australia. Among these, 652 underwent diaphragmatic intervention. The analysis was preformed according to histological subtype. First diaphragm interventions were compared to non-diaphragmatic CRS. Secondly, diaphragm resection was compared to diaphragm stripping. Overall survival and recurrence free survival was assessed based on histological diagnosis. RESULTS: There were no differences between the resection and stripping groups for the colorectal cohort. For mesothelioma, increased incidences of pleural effusions in the resection group were noted (63% vs.28%, p = 0.017). In HAMNs, the resection group was associated with increased reoperations (42% vs. 15%, p = 0.03) and in hospital death (16.7% vs. 0.6%, p = 0.012). Resection in LAMNs were linked with increased transfusion requirements (9 vs. 6, p = 0.01), reoperation (39% vs. 23%, p = 0.05) and prolonged length of stay (34 days vs. 25 days, p = 0.02). There were no differences in overall survival and recurrence free survival in colorectal cancer. Median overall survival was decreased in mesothelioma by 20 months. In LAMNs the median survival was significantly decreased for the resection group. Similarly, the resection group had a 4-month earlier recurrence. CONCLUSION: We conclude that diaphragm interventions are an essential part of CRS. They are associated with increased perioperative morbidity. This morbidity is not attributable to whether the patient underwent diaphragm stripping or resection. However in mesothelioma and LAMNs, requiring diaphragm resection is likely to be an indicator for tumor aggression.


Assuntos
Neoplasias do Apêndice/mortalidade , Quimioterapia do Câncer por Perfusão Regional , Neoplasias Colorretais/mortalidade , Procedimentos Cirúrgicos de Citorredução , Diafragma/cirurgia , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/terapia , Adenocarcinoma/mortalidade , Transfusão de Sangue/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Neoplasias Pulmonares/mortalidade , Masculino , Análise por Pareamento , Mesotelioma/mortalidade , Pessoa de Meia-Idade , Neoplasias Peritoneais/secundário , Derrame Pleural Maligno/epidemiologia , Pneumonia/epidemiologia , Pneumotórax/epidemiologia , Pontuação de Propensão , Reoperação/estatística & dados numéricos , Estudos Retrospectivos
11.
J Thorac Cardiovasc Surg ; 159(3): 1120-1127.e3, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31606164

RESUMO

OBJECTIVE: Contralateral recurrence in patients with primary spontaneous pneumothorax is approximately 15%. If positive for blebs, the recurrence rate increases to 26%. This study seeks to determine whether simultaneous contralateral video-assisted thoracic surgery blebs excision would effectively lower the contralateral incidence of pneumothorax in patients undergoing surgery for ipsilateral primary spontaneous pneumothorax. METHODS: Between January 2009 and December 2015, 335 patients with primary spontaneous pneumothorax, surgically treated in a single institution, were retrospectively studied. The median follow-up was 75 (50-99) months. All patients received video-assisted thoracic surgery blebectomy/bullectomy with pleural abrasions. They were classified into 3 groups: (1) ipsilateral video-assisted thoracic surgery without contralateral blebs/bullae included 142 patients with ipsilateral primary spontaneous pneumothorax without contralateral blebs/bullae only receiving ipsilateral video-assisted thoracic surgery; (2) ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae included 123 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs/bullae receiving only ipsilateral video-assisted thoracic surgery; and (3) bilateral video-assisted thoracic surgery with contralateral blebs/bullae included 70 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs/bullae receiving 1-stage bilateral video-assisted thoracic surgery. Demographic data, perioperative details, recurrence patterns, recurrence-free survivals, and risk factors were compared. RESULTS: The percentage of contralateral recurrence for the ipsilateral video-assisted thoracic surgery without contralateral blebs/bullae, ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae, and bilateral video-assisted thoracic surgery with contralateral blebs/bullae groups differed significantly (0.7%, 14.6%, and 2.9%, respectively; P = .002). Multivariate analysis using the Cox proportional hazard model revealed that age less than 18 years (hazard ratio, 2.71; 95% confidence interval, 1.14-6.44; P = .024) and ipsilateral video-assisted thoracic surgery with contralateral blebs/bullae (hazard ratio, 22.13, 95% confidence interval, 2.96-165, P = .003) were predictors of contralateral recurrence, of which recurrence-free survival was notably different among groups as determined by Kaplan-Meier analysis (P < .0001). CONCLUSIONS: Simultaneous contralateral blebectomy in patients with primary spontaneous pneumothorax receiving ipsilateral video-assisted thoracic surgery significantly lowered future contralateral recurrence.


Assuntos
Vesícula/cirurgia , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida , Adolescente , Adulto , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pneumotórax/diagnóstico por imagem , Pneumotórax/epidemiologia , Intervalo Livre de Progressão , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Cirurgia Torácica Vídeoassistida/efeitos adversos , Fatores de Tempo , Adulto Jovem
12.
Interact Cardiovasc Thorac Surg ; 30(3): 337-345, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31858124

RESUMO

Primary spontaneous pneumothorax (PSP) is one of the most common thoracic diseases affecting adolescents and young adults. Despite the high incidence of PSP and the availability of several international guidelines for its diagnosis and treatment, a significant behavioural heterogeneity can be found among those management recommendations. A working group of the Italian Society of Thoracic Surgery summarized the best evidence available on PSP management with the methodological tool of a systematic review assessing the quality of previously published guidelines with the Appraisal of Guidelines for Research and Evaluation (AGREE) II. Concerning PSP physiopathology, the literature seems to be equally divided between those who support the hypothesis of a direct correlation between changes in atmospheric pressure and temperature and the incidence of PSP, so it is not currently possible to confirm or reject this theory with reasonable certainty. Regarding the choice between conservative treatment and chest drainage in the first episode, there is no evidence on whether one option is superior to the other. Video-assisted thoracic surgery represents the most common and preferred surgical approach. A primary surgical approach to patients with their first PSP seems to guarantee a lower recurrence rate than that of a primary approach consisting of a chest drainage positioning; conversely, the percentage of futile surgical interventions that would entail this aggressive attitude must be carefully evaluated. Surgical pleurodesis is recommended and frequently performed to limit recurrences; talc poudrage offers efficient pleurodesis, but a considerable number of surgeons are concerned about administering this inert material to young patients. CLINICAL TRIAL REGISTRATION NUMBER: International Prospective Register of Systematic Reviews (PROSPERO): CRD42018084247.


Assuntos
Tubos Torácicos , Pleurodese/métodos , Pneumotórax/epidemiologia , Talco/farmacologia , Cirurgia Torácica Vídeoassistida/métodos , Saúde Global , Humanos , Incidência , Pneumotórax/diagnóstico , Pneumotórax/terapia
13.
PLoS One ; 14(12): e0225612, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31790460

RESUMO

AIM: Cardiac resynchronization therapy (CRT) is a valid therapeutic option for patients with heart failure (HF). However, the elderly population was not well represented in the guidelines. The primary end point was to evaluate the impact of advanced age on clinical response and cardiovascular and total mortality of patients undergoing CRT. The secondary end point was to assess the rate of acute complications related to the procedure. METHODS AND RESULTS: A total of 249 consecutive patients with HF and optimized treatment, QRS ≥ 120 ms, ejection fraction (EF) ≤ 35% and functional class (FC) III/ IV (NYHA) underwent CRT and divided into 3 groups: Group I-< 65 years-88/ 249 (35%); Group II- 65 to 75 years (old)- 72/ 249 (29%); Group III-≥ 75 years (very old)- 89/ 249 (36%). The improvement in FC and increase in EF (>10%) and/ or decrease in the left ventricular end systolic diameter (LVESD) >15% were the criteria of responsiveness. The favorable clinical response (p = ns) and cardiovascular mortality (p = 0.737) was similar in the 3 groups. In the group of very old patients, a significant increase in total mortality was observed (p = 0.03). The rate of acute complications related to the procedure did not differ between the groups (p = ns). CONCLUSION: The response to CRT and cardiovascular mortality were not affected by the advanced age and should not be an exclusion factor of this therapy. The procedure has been shown to be safe in elderly patients due to low rate of acute complications.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/efeitos adversos , Insuficiência Cardíaca/terapia , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/epidemiologia , Tamponamento Cardíaco/etiologia , Desfibriladores Implantáveis/efeitos adversos , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
15.
Am Surg ; 85(10): 1134-1138, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657309

RESUMO

Traumatic esophageal injury is a highly lethal but rare injury with minimal data in the trauma population. We sought to provide a descriptive analysis of esophageal trauma (ET) to identify the incidence, associated injuries, interventions, and outcomes. We hypothesized that blunt trauma is associated with higher risk of death than penetrating trauma. The Trauma Quality Improvement Program (2010-2016) was queried for patients with ET. Patients with blunt and penetrating trauma were compared using chi-square and Mann-Whitney U tests. A multivariable logistic regression model was used to determine risk of mortality. Of 1,403,466 adult patients, 651 (<0.01%) presented with ET. The most common associated thoracic injuries were rib fractures (38.7%) and pneumothorax (26.7%). More patients with a penetrating mechanism underwent open repair of the esophagus than those with blunt mechanism (46.2% vs 11.7%, P < 0.001). After controlling for covariates, there was no difference in risk of mortality between blunt and penetrating trauma (P = 0.65). The mortality rate for patients with esophageal injury surviving greater than 24 hours was 7.5 per cent. In this large national database analysis, ET was rare and most commonly associated with rib fractures and pneumothorax. Contrary to our hypothesis, the risk of mortality was equivalent between blunt and penetrating ET.


Assuntos
Esôfago/lesões , Ferimentos não Penetrantes/mortalidade , Ferimentos Penetrantes/mortalidade , Adulto , Distribuição de Qui-Quadrado , Esôfago/cirurgia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação , Modelos Logísticos , Masculino , Morbidade , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumotórax/complicações , Pneumotórax/epidemiologia , Melhoria de Qualidade , Estudos Retrospectivos , Fraturas das Costelas/complicações , Fraturas das Costelas/epidemiologia , Fatores de Risco , Estatísticas não Paramétricas , Stents/estatística & dados numéricos , Taxa de Sobrevida , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/cirurgia
16.
Clin Respir J ; 13(12): 765-772, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31487103

RESUMO

INTRODUCTION: Peripheral pulmonary lesions (PPL) are difficult to diagnose. We analysed the diagnostic values and risks of endobronchial ultrasonography with a guide sheath (EBUS-GS) and computed tomography-guided transthoracic needle aspiration (CT-TTNA) in diagnosing PPL. METHODS: We collected 250 cases received EBUS-GS examination, and 279 cases received CT-TTNA examination. We analysed the diagnosis results and the complications of each operation and determined the relevant indications. RESULTS: Biopsy was successful in 239 cases (95.6%) using EBUS-GS and in 279 cases (100%) using CT-TTNA. Lesions were smaller than or equal to 30 mm for biopsy using EBUS-GS in 60.7% of the cases. The distances of lesions from the chest wall were greater than 80 mm for EBUS-GS examination in 89.1% of the cases. The diagnostic rate of EBUS-GS was 78.2%, including 41.8% (100 cases) malignant diseases. EBUS-GS is a highly safe method. The distances of lesions from the chest wall were no greater than 80 mm for CT-TTNA examination in 90.0% of the cases. The diagnosis rate using CT-TTNA was 94.6%, including 90.0% (251 cases) malignant diseases. For CT-TTNA, there is a high chance of complications such as pneumothorax and intrapulmonary hemorrhage. CONCLUSION: EBUS-GS and CT-TTNA each have their own limitations. EBUS-GS has a slightly lower diagnostic rate but higher safety, while CT-TTNA has a higher diagnostic rate but requires attention to complications. For lesions 80 mm more from the chest wall, we recommend EBUS-GS. For lesions 80 mm from or closer to the chest wall, we recommend CT-TTNA.


Assuntos
Endossonografia/métodos , Biópsia Guiada por Imagem/instrumentação , Pulmão/diagnóstico por imagem , Neoplasias/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/métodos , China/epidemiologia , Endossonografia/efeitos adversos , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/patologia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Parede Torácica/patologia , Tomografia Computadorizada por Raios X/métodos
18.
Semin Respir Crit Care Med ; 40(3): 314-322, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31525807

RESUMO

Pneumothorax is a common pathology, but optimal management strategies are not yet defined. There are significant differences in international guidelines and therefore variation in clinical practice.There is increasing interest in pneumothorax research, particularly primary spontaneous pneumothorax (PSP), with evidence of lung abnormalities in this group without clinically apparent lung disease and recently completed clinical trials aiming to optimize management. The most robust evidence base is that of the equivalence of needle aspiration and chest tube insertion for initial management of PSP; although, patients with secondary spontaneous pneumothorax may also benefit. A convincing case for surgical intervention or thoracoscopy and talc poudrage to prevent recurrence at first episode in PSP has yet to be made. Clinicians should be vigilant for PSP being the first manifestation of a systemic disease, and should have a low threshold for onward referral. Time to change guidelines? First, chest tube drainage and hospitalization without recurrence prevention should no longer be standard treatment, as this has no advantage over the less invasive manual aspiration, which moreover can be performed on an outpatient basis in an important number of patients. The results of recent trials in conservative and ambulatory management are eagerly awaited. Second, shared decision-making should become more important with the well-informed patient, who may want to avoid a 1 in 3 recurrence rate and therefore will have the possibility to choose treatment including recurrence prevention even after the first episode of PSP. Third, surgical research should urgently make clear if the current practice of resection of emphysema-like changes is routinely necessary, alongside pleurodesis. Future studies should utilize risk stratification by clinical and radiological parameters (e.g., high-resolution computed tomography scanning and digital air leak monitoring) to predict short- and long-term outcomes, and hence personalize management.


Assuntos
Pneumotórax/epidemiologia , Pneumotórax/terapia , Guias de Prática Clínica como Assunto , Assistência Ambulatorial/métodos , Tubos Torácicos , Drenagem/métodos , Humanos , Participação do Paciente , Pleurodese/métodos , Pneumotórax/etiologia , Toracentese/métodos , Toracoscopia/métodos , Toracotomia/métodos
19.
Semin Respir Crit Care Med ; 40(3): 402-409, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31525815

RESUMO

There are several pleural diseases that occur either predominantly or exclusively in females. Most of these entities are related to obstetric or gynecological conditions. In this article, we will provide an overview of Meigs' syndrome, ovarian hyperstimulation syndrome, endometriosis, catamenial pneumothorax, catamenial hemothorax, pleural effusions that occur in the peripartum period, lymphangioleiomyomatosis, and malignant pleural effusions related to breast cancer. As most of these diagnoses are rare, considerable expertise is required to identify, diagnose, and manage these patients. The aim of this article is to present an overview of the most common forms of pleural disease affecting women, and to provide an easy reference source on current best practice.


Assuntos
Doenças Pleurais/epidemiologia , Doenças Pleurais/terapia , Neoplasias da Mama/epidemiologia , Feminino , Doenças dos Genitais Femininos/epidemiologia , Humanos , Linfangiomioma/epidemiologia , Derrame Pleural , Pneumotórax/epidemiologia , Período Pós-Parto , Gravidez , Complicações na Gravidez/epidemiologia
20.
Aerosp Med Hum Perform ; 90(10): 867-871, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31558195

RESUMO

BACKGROUND: Preventive treatment for incidentally detected blebs or bullae is required for fast jet pilots, but their aeromedical risk is not clearly proven.METHODS: This is a retrospective study and includes 46 pilots 40 yr and older with incidentally detected emphysema-like changes (ELCs) comprising blebs or bullae in low-dose chest CT (LDCT) during health screening. Two radiologists retrospectively reviewed imaging features. Statistical analysis was done using independent t-tests and bivariate analysis.RESULTS: Among 46 pilots, 39 pilots flew fast jet aircraft and 7 pilots flew nonfast jet aircraft. The mean follow-up period was 1531 d and the LDCT follow-up interval mean period was 424.4 d. There was no evidence of rupture in incidentally detected ELCs during the follow-up period. The mean size of the ELCs was 19.15 mm. There were five cases showing changes in size. There was a statistically significant correlation between the size of ELCs and height. There were no statistically significant differences in the size or number of ELCs relating to smoking status or aircraft type, and there were no statistically significant correlations between the size or number of ELCs and multiple factors, including smoking quantity, flight time, age, BMI, and weight.CONCLUSION: This study demonstrates the aeromedical safety of incidentally detected ELCs in pilots 40 yr and older without underlying lung disease. The results indicate no need for recommending preventive treatment for ELCs in pilots 40 yr and older, even those flying fast jet aircraft, as a requisite to continue their flight duties. KEYWORDS: bleb, bulla, pilot, CT.Bang S, Yang S, Cho SW, Kim DH, Kang H. Follow-up of blebs and bullae in pilots 40 years and older using CT. Aerosp Med Hum Perform. 2019; 90(10):867-871.


Assuntos
Medicina Aeroespacial , Militares/estatística & dados numéricos , Pilotos/estatística & dados numéricos , Pneumotórax/epidemiologia , Enfisema Pulmonar/epidemiologia , Adulto , Aeronaves , Seguimentos , Humanos , Incidência , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Pneumotórax/prevenção & controle , Enfisema Pulmonar/complicações , Enfisema Pulmonar/terapia , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Tomografia Computadorizada por Raios X
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