RESUMO
This meta-analysis aimed to compare the outcomes of video-assisted thoracic surgery (VATS) and open thoracotomy in pediatric patients undergoing pulmonary metastasectomy for various malignancies. We systematically searched PubMed, Embase, and Cochrane Library databases for studies comparing VATS and open thoracotomy in pediatric patients. The treatment effects for continuous outcomes were compared using mean differences (MDs), and binary endpoints were evaluated using odds ratios (ORs), with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analyses were performed using R software, version 4.4.1. A total of 4 studies involving 1,541 patients were included. There were no significant differences in overall survival (OR 0.65; 95% CI 0.36-1.18; p = 0.16) or disease-free survival (DFS) (OR 1.65; 95% CI 0.88-3.10; p = 0.12) between groups. However, VATS was associated with a significantly reduced length of hospital stay (MD -2.06 days; 95% CI - 2.93 to - 1.20; p < 0.01). This meta-analysis suggests that VATS significantly reduces hospitalization duration compared to open thoracotomy, with no significant difference in survival outcomes. Future prospective studies are needed to validate these findings and optimize patient selection criteria. International Prospective Register of Systematic Reviews; No: CRD42024581284; URL: https://www.crd.york.ac.uk/prospero/ .
Assuntos
Neoplasias Pulmonares , Metastasectomia , Cirurgia Torácica Vídeoassistida , Toracotomia , Humanos , Cirurgia Torácica Vídeoassistida/métodos , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/secundário , Metastasectomia/métodos , Criança , Toracotomia/métodos , Resultado do Tratamento , Tempo de Internação/estatística & dados numéricos , Pneumonectomia/métodosRESUMO
La infestación por Paragonimus spp. clásicamente se da por la ingestión de crustáceos de agua dulce, crudos, poco cocidos o en forma de ceviches. Se presenta el caso de un paciente adulto que conscientemente ingería cangrejos crudos y desarrolló sintomatología pulmonar con tos y disnea, lo cual lo llevó a efectuarse estudios broncoscópicos cuyo resultado citológico del cepillado bronquial fue de adenocarcinoma pulmonar. Se le realizó biopsia pulmonar y la patología fue concluyente de la presencia de huevecillos y formas larvarias de Paragonimus spp., que es una entidad poco frecuente en Guatemala. El paciente recibió tratamiento con prazicuantel y mostró buena res-puesta clínica.
Infestation by Paragonimus spp. classically occurs through the ingestion of freshwater crustaceans, raw, undercooked or in the form of "ceviches". We present the case of an adult patient who consciously ingested raw crabs and developed pulmonary symptoms with cough and dyspnea, which leaded him to undergo bronchoscopic studies, whose cytological result of bronchial brushing was pulmonary adenocarcinoma. A lung biopsy was performed and the pathology was conclusive of the presence of eggs and larval forms of Paragonimus spp., which is a rare entity in Guatemala. Patient received treatment with praziquantel and showed a good clinical response.
Assuntos
Humanos , Masculino , Adulto , Paragonimíase/diagnóstico , Paragonimus/isolamento & purificação , Praziquantel/uso terapêutico , Crustáceos , Neoplasias Pulmonares , Biópsia , Broncoscopia , Diagnóstico por Imagem , Toracotomia , Tosse , Diagnóstico Diferencial , Dispneia , GuatemalaRESUMO
Introducción: La leiomiomatosis esofágica es una neoplasia benigna con una incidencia dentro de los tumores del esófago extremadamente baja y en ocasiones difícil de categorizar como neoplasia o miopatía. Caso clínico: Se reporta el caso de una joven de 24 años que consultó por disfagia pro- gresiva de un año de evolución y antecedente de haberle descubierto una "mancha" en el pulmón diez años atrás. Las imágenes muestran masa que ocupa el tercio medio e inferior del esófago y megaesófago proximal por obstrucción a nivel de cardias. Se rea- lizó esofagectomía total, tubulización y ascenso gástrico con piloroplastía más anastomosis esófago gástrica latero lateral a nivel cervical. La patología confirmó la histología de leiomiomatosis esofágica. Conclusión: Es una patología muy rara con pocos casos reportados.
Introduction: Esophageal leiomyomatosis is a benign neoplasm with an extremely low incidence of esophageal tumors and is sometimes difficult to categorize as a neoplasm or myopathy. Clinical Case: The case of a 24-year-old girl, who consulted for progressive dysphagia of one year of evolution and a history of having discovered a "spot" on her lung ten years ago, is reported. The images show a mass that occupies the middle and lower third of the esophagus and proximal megaesophagus due to obstruction at the level of the cardia. Total esophagectomy, tubulization and gastric ascent with pyloroplasty plus lateral esophagogastric anastomosis at the cervical level were performed. The pathology confirms the histology of esophageal leiomyomatosis. Conclusion: It is a very rare pathology with few reported cases.
Assuntos
Humanos , Feminino , Adulto , Neoplasias Esofágicas/cirurgia , Leiomiomatose/diagnóstico , Leiomioma , Biópsia , Diagnóstico por Imagem , Imuno-Histoquímica , Jejunostomia , Toracotomia , Transtornos de Deglutição , Esofagectomia , Diagnóstico Diferencial , EndoscopiaRESUMO
Introducción. La perforación esofágica se define como la ruptura transmural del esófago. Existen diferentes causas, como neoplásicas, traumáticas, lesión por cuerpos extraños, ingesta de cáusticos, iatrogénicas o espontáneas, denominadas Síndrome de Boerhaave. La tasa de mortalidad es alta y oscila entre 40-60 % con manejo óptimo, hasta el 100 % sin tratamiento. Caso clínico. Se presenta el caso de una paciente de 70 años, que ingresó por 5 días de sensación de globus faríngeo, disnea y dolor torácico. Se realizó una tomografía computarizada de tórax donde se visualizó un derrame pleural derecho, que fue manejado con toracostomía cerrada. Posteriormente, se visualizó la salida de material alimentario por la sonda de toracostomía, por lo que se hizo una nueva tomografía de tórax y abdomen encontrando una fístula esofagopleural. En una esofagografía por tomografía donde se vio extravasación del medio de contraste en la región infracarinal hacia espacio pleural derecho. Resultados. Fue llevada a toracotomía, encontrando empiema y atrapamiento del lóbulo inferior derecho por abundante fibrina, pus y restos alimentarios, secundario a perforación esofágica del tercio medio. Se practicó esofagorrafia, pleurectomía y decorticación. Se continuó manejo endoscópico con sistema de vacío de forma seriada. Conclusiones. Las perforaciones esofágicas son un desafío para los cirujanos, tanto en el enfoque diagnóstico inicial, como en el tratamiento. Conocer los abordajes endoscópico, quirúrgico y mixto ayuda a ampliar las opciones de manejo en estos pacientes. El tratamiento oportuno, las indicaciones no operatorias y las nuevas medidas endoscópicas para el manejo impactan en la mortalidad.
Introduction. Esophageal perforation is defined as a transmural rupture of the esophagus. There are different causes, such as neoplastic, traumatic, foreign body, caustic ingestion, iatrogenic or spontaneous, called Boerhaave Syndrome. The mortality rate is high and ranges between 40-60% with optimal management, up to 100% mortality without treatment. Clinical case. The case of a 70-year-old patient is presented, who was admitted after five days of pharyngeal globus sensation, dyspnea, and chest pain. A CT scan of the chest was performed were a right pleural effusion was observed, which was managed with closed thoracostomy. The exit of food material through the thoracostomy tube was observed. Subsequently, a new CT scan of chest and abdomen was performed, finding an esophagopleural fistula. In a CT esophagography where extravasation of contrast medium was seen in the infracarinal region into the right pleural space. Results. She was taken to thoracotomy, finding empyema and entrapment of the right lower lobe due to abundant fibrin, pus and food debris, secondary to esophageal perforation of the middle third. Esophagorrhaphy, pleurectomy and decortication were performed. Endoscopic management with a vacuum system was continued on a serial basis. Conclusions. Esophageal perforations are a challenge for surgeons, both in the initial diagnostic approach and in treatment. Knowing the endoscopic, surgical and mixed approaches helps to expand the management options in these patients. Timely treatment, non-operative indications and new endoscopic measures for management affect mortality.
Assuntos
Humanos , Endoscopia do Sistema Digestório , Perfuração Esofágica , Toracotomia , Fístula Esofágica , Procedimentos Cirúrgicos Minimamente Invasivos , Doenças do EsôfagoRESUMO
Surgical interventions on the pulmonary valve in adults have been increasing over the years, as patients with congenital heart diseases are experiencing extended lifespans. Reoperations involving multiple sternotomies exhibit elevated morbidity and mortality rates. With nearly two decades of experience in minimally invasive video-assisted mitral valve surgery, we have chosen the left anterior minithoracotomy approach for addressing the pulmonary valve and right ventricular outflow tract in adult patients. The technique demonstrates safety based on initial outcomes, minimizing potential complications from multiple cardiac reapproaches. Our series of five patients demonstrated an absence of postoperative complications or mortality.
Assuntos
Implante de Prótese de Valva Cardíaca , Valva Pulmonar , Toracotomia , Humanos , Valva Pulmonar/cirurgia , Toracotomia/métodos , Implante de Prótese de Valva Cardíaca/métodos , Adulto , Feminino , Masculino , Resultado do Tratamento , Adulto Jovem , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodosRESUMO
Infective endocarditis in the pediatric population is a rare condition that may or may not be associated with a congenital heart disease. Current treatment modalities are based on long-term antibiotic therapy and surgical resection as the first option for cases of persistent vegetation. We present a case of successful percutaneous retrieval of a vegetation in a patent ductus arteriosus, that extended to the pulmonary artery trunk in a pediatric patient. This is the first report in the literature on this type of extraction of vegetation in the ductus arteriosus without thoracotomy.
A endocardite infecciosa na população pediátrica é uma condição rara que pode ou não estar associada a uma cardiopatia congênita. As modalidades de tratamento atuais baseiam-se na antibioticoterapia de longo prazo e na ressecção cirúrgica como primeira opção para casos de vegetação persistente. Apresentamos um caso de recuperação percutânea bem-sucedida de vegetação em canal arterial patente, que se estendia ao tronco da artéria pulmonar em um paciente pediátrico. Este é o primeiro relato na literatura desse tipo de extração de vegetação no canal arterial sem toracotomia.
Assuntos
Permeabilidade do Canal Arterial , Humanos , Permeabilidade do Canal Arterial/cirurgia , Resultado do Tratamento , Toracotomia/métodos , Endocardite Bacteriana/cirurgia , Masculino , FemininoRESUMO
This study aimed to conduct a systematic review and meta-analysis comparing video-assisted thoracoscopic surgery (VATS) and open thoracotomy (OT) in the context of pulmonary metastasectomy. Three databases were assessed. The primary outcome was overall survival. The secondary outcomes were recurrence-free survival, ipsilateral recurrence, and hospital length of stay (LOS). Hazard ratios (HRs), odds ratios (ORs), and mean difference (MD) with 95% confidence intervals (CIs) were calculated. Reconstruction of time-to-event data and sensitivity analyses were performed for the primary endpoint. After screening, 11 studies were included encompassing 2159 patients undergoing lung metastasectomy (VATS: 827; OT: 1332). Compared to OT, patients who underwent VATS had higher overall survival rates (HR 0.75; 95% CI 0.67-0.85; p < 0.01), no significant difference in recurrence-free survival (HR 1.07; 95% CI 0.88-1.29; p = 0.48), shorter hospital LOS (MD -1.99 days; 95% CI -2.59 to -1.39; p < 0.01), and no significant difference in ipsilateral recurrence rates (OR 0.86; 95% CI 0.52-1.42; p = 0.56). For patients undergoing pulmonary metastasectomy, VATS strategy is associated with higher survival rates and reduced hospital LOS when compared with OT. Moreover, metastasis recurrence does not seem to be associated with long-term mortality in this population.
Assuntos
Neoplasias Pulmonares , Cirurgia Torácica Vídeoassistida , Toracotomia , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodosRESUMO
OBJECTIVES: To evaluate the early and late results of surgical treatment of patients with bronchiectasis, comparing the Video-Assisted Thoracic Surgery (VATS) vs. the open thoracotomy (OT). METHODS: Observational retrospective study of patients who underwent surgery for bronchiectasis. Patients were divided into two groups according to surgical access OT/VATS. Variables collected included gender, age, preoperative symptoms, etiology, segments involved, FVC and FEV1, type of surgical resection, complications, mortality, and length of hospital stay. Late surgical results were classified as excellent, complete remission of symptoms; good, significative improvement; and poor, little/no improvement. RESULTS: 108 surgical resections (103 patients). OT group 54 patients (52.4%) vs. VATS 49 (47.6%). A high percentage of complications was observed, but no difference between the OT (29.6%) and VATS (24.5%) groups was found. Post-operative hospital stay was shorter in the VATS group (5.4 days) vs. the OT group (8.7 days (p=0.029). 75% of the patients had a late follow-up; the results were considered excellent in 71.4%, good in 26%, and poor in 2.6%. Regarding bronchiectasis distribution, an excellent percentage was obtained at 82.1% in patients with localized bronchiectasis and 47.5% with non-localized bronchiectasis, p=0.003. CONCLUSIONS: VATS leads to similar results regarding morbidity, compared to OT. However, VATS was related to shorter hospital stays, reflecting the early recovery. Late results were excellent in most patients, being better in patients with localized bronchiectasis. VATS should be considered a preferable approach for bronchiectasis lung resection whenever possible.
Assuntos
Bronquiectasia , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Humanos , Bronquiectasia/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Resultado do Tratamento , Pneumonectomia/métodos , Pneumonectomia/efeitos adversos , Toracotomia/métodos , Fatores de Tempo , Idoso , AdultoRESUMO
INTRODUCTION: With the introduction of minimally invasive cardiac surgery, more commonly cases of lung herniation are starting to appear. Acquired lung hernias are classified as postoperative, traumatic, pathologic, and spontaneous. Up to 83% of lung hernias are intercostal. Herein, we describe patients presenting with intercostal lung hernias following minimally invasive cardiac surgery at a single center in Medellín, Colombia. METHODS: We conducted a retrospective search of all patients presenting with intercostal lung hernias secondary to minimally invasive cardiac surgery at our clinic in Medellín since the beginning of our program, from 2010 to 2022. Mini-sternotomies were excluded from our study. We reviewed the incision type and other possible factors leading to intercostal lung hernia development. We also describe the approach taken for these patients. RESULTS: From 2010 up until 2022, 803 adult patients underwent minimally invasive cardiac surgeries through a mini-thoracotomy. At the time of data retrieval, nine patients presented with intercostal lung hernias at the previous incision site. Five hernias (55%) were from right 2nd intercostal parasternal mini-thoracotomies for aortic valve surgeries. Four hernias (45%) were from right 4th intercostal lateral mini-thoracotomies for mitral valve surgeries. Our preferred repair technique is a video-assisted thoracoscopic mesh approach. CONCLUSION: Minimally invasive cardiac surgical approaches are becoming more routine. Proper wound closure is critical in preventing lung hernias. Additionally, timely diagnosis and opportune hernia surgery using video-assisted thoracoscopic mesh repair can prevent further complications.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Pneumopatias , Procedimentos Cirúrgicos Minimamente Invasivos , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Idoso , Pneumopatias/etiologia , Pneumopatias/cirurgia , Toracotomia/efeitos adversos , Toracotomia/métodos , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Hérnia/etiologia , Adulto , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Complicações Pós-Operatórias/etiologiaRESUMO
Introducción: El sarcoma de Ewing es un tumor maligno de alto grado con localización principalmente ósea; se han reportado aproximadamente 12% con presentación extra-esquelética. Actualmente, existen alrededor de 20 casos descritos en la literatura con origen mediastinal y 10 casos con origen pulmonar. Caso clínico: Se presenta el caso de una mujer de 25 años con un mes de disnea y dolor torácico, con el hallazgo de derrame pleural masivo y tumoración mediastinal en hemitórax derecho. Se le realiza toracotomía anterior bilateral con esternotomía transversa de Clamshell, con resección parcial que demuestra, por patología, sarcoma monomórfico de alto grado e inmunohistoquímica concluyente de sarcoma de Ewing. Conclusión: Este caso es una entidad rara y conlleva un reto diagnóstico para el clínico; sin embargo, debe sospecharse considerando la presentación clínica y radiológica del paciente, buscando incrementar la tasa de supervivencia mediante el diagnóstico y tratamiento oportuno.
Introduction: Ewing's sarcoma is a high-grade malignant tumor with mainly bony lo-calization; approximately 12% have been reported with extraskeletal presentation. Currently, there are about 20 cases described in the literature with mediastinal origin and 10 pulmonary cases. Case Report: We present the case of a 25-year-old woman with one month of dysp-nea and chest pain, with massive pleural effusion and mediastinal tumor in the right hemithorax who underwent bilateral anterior thoracotomy with Clamshell transverse sternotomy, with partial resection demonstrating, by pathology, high-grade monomorphic sarcoma and conclusive immunohistochemistry of Ewing's sarcoma. Conclusion: This case is a rare entity and involves a diagnostic challenge for the clinician; however, it should be suspected considering the clinical and radiological presentation of the patient, seeking to increase the survival rate through timely diagnosis and treatment.
Assuntos
Humanos , Feminino , Adulto , Sarcoma de Ewing/diagnóstico , Neoplasias Ósseas , Neoplasias do Mediastino/cirurgia , Derrame Pleural , Biópsia , Dor no Peito , Síndrome da Veia Cava Superior , Diagnóstico por Imagem , Toracotomia , Biomarcadores Tumorais , Agroquímicos , Dispneia , Esternotomia , LinfadenopatiaRESUMO
BACKGROUND: Myelolipoma is an uncommon benign tumor composed of mature adipose tissue and hematopoietic elements. These tumors generally affect the adrenal glands, with anomalous presentations being rare and with few cases described in the literature. Most myelolipomas are asymptomatic and discovered incidentally, either through imaging tests or at autopsies. However, depending on the location and size of the lesion, myelolipomas can cause symptoms of mass effect. This article aims to report a very rare presentation of a symptomatic primary myelolipoma affecting the ribs. CASE PRESENTATION: A 21-year-old white female patient presented with a complaint of burning chest pain over 3 months, with gradual worsening in intensity, accompanied by a progressively growing bulge in the right thoracic wall. The patient underwent thoracotomy of the fifth and sixth ribs with complete excision of the lesion with a safety margin. Thoracic wall reconstruction was performed using a polypropylene mesh. The patient had a good postoperative course and was discharged on postoperative day 3. Histopathological examination revealed a histological image consistent with myelolipoma. CONCLUSIONS: This report underscores the importance of considering a myelolipoma diagnosis for tumor masses in the ribs.
Assuntos
Mielolipoma , Costelas , Humanos , Mielolipoma/cirurgia , Mielolipoma/patologia , Mielolipoma/diagnóstico , Mielolipoma/diagnóstico por imagem , Feminino , Costelas/patologia , Costelas/cirurgia , Costelas/diagnóstico por imagem , Adulto Jovem , Toracotomia , Dor no Peito/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Neoplasias Ósseas/cirurgia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/diagnósticoRESUMO
El dolor es un síntoma frecuente de presentación en los casos de cáncer pulmonar y es un dolor refractario debido a la multiplicidad de generadores de dolor. Las presentaciones pueden ser una invasión pleural, metastasis costales, invasión mixta o síndrome costo-pleural, tumor de Pancoast, y metástasis vertebral con o sin invasion paravertebral. Se han desarrollado terapias intervencionales mínimamente invasivas para tratar el dolor, que en etapas tempranas en pacientes con dolor no controlado mejoran su condición de salud, mejoran su rendimiento para enfrentar la enfermedad y su tratamiento, y evitan o retrasan la escalada de opioides con sus efectos adversos asociados. Se requiere estandarizar las técnicas, mejorar la calidad de los ensayos clínicos y desarrollar guías de práctica clínica en un trabajo conjunto con oncología.
Pain is a frequent presenting symptom in cases of lung cancer and it is a refractory pain due to the multiplicity of pain generators. Clinical presentations may be pleural invasion, rib metastasis, mixed invasion or costo-pleural syndrome, Pancoast tumor, and vertebral metastasis with or without paravertebral invasion. Minimally invasive interventional therapies have been developed to treat pain, which in early stages in patients with uncontrolled pain improve their health condition, improve their performance in coping with the disease and its treatment, and prevent or delay the escalation of opioids with their associated side effects. It is necessary to standardize the techniques, improve the quality of clinical trials and develop clinical practice guidelines in a joint effort with oncology.
Assuntos
Humanos , Dor no Peito/terapia , Dor do Câncer/terapia , Neoplasias Pulmonares/complicações , Ondas de Rádio/uso terapêutico , Toracotomia/efeitos adversos , Neuropatias do Plexo Braquial/terapia , Denervação , Mastectomia/efeitos adversosRESUMO
Se presenta a un paciente con liposarcoma mediastinal gigante con dolor torácico, disnea, cuyos estudios por imágenes revelaban la presencia de una gran tumoración de 42 cm en su diámetro mayor que abarcaba todo el mediastino, comprometía ambas cavidades torácicas, rechazaba los pulmones, corazón y grandes vasos. La biopsia con aguja cortante bajo guía ecográfica fue informada como liposarcoma. El paciente tuvo resección completa del tumor mediante la incisión Clamshell. En el post operatorio inmediato, presentó shock circulatorio más disfunción multiorgánica (DOMS): plaquetopenia, insuficiencia renal aguda con necesidad de soporte dialítico, injuria hepática. El soporte y monitoreo especializado en la Unidad de Cuidados Intensivos (UCI) permitió mejoría clínica y buena evolución. Salió de alta en buenas condiciones.
We present a patient with giant mediastinal liposarcoma with chest pain, dyspnea, whose imaging studies revealed the presence of a large tumor measuring 42 cm in its greatest diameter that covered the entire mediastinum, involved both thoracic cavities, rejected the lungs, heart and big glasses. The sharp needle biopsy under ultrasound guidance was reported as liposarcoma. The patient had complete resection of the tumor through the Clamshell incision. In the immediate postoperative period, he presented circulatory shock plus multiple organ dysfunction (DOMS): plateletopenia, acute renal failure with the need for dialytic support, liver injury. Specialized support and monitoring in the Intensive Care Unit (ICU) allowed clinical improvement and good evolution. He was discharged in good condition.
Assuntos
Humanos , Masculino , Adulto , Toracotomia , Lipossarcoma/cirurgia , Neoplasias do Mediastino/diagnóstico , Choque , Dor no Peito , Tomografia , Tosse , Cuidados Críticos , Tratamento Farmacológico , Dispneia , Biópsia Guiada por Imagem , Insuficiência de Múltiplos Órgãos/cirurgiaRESUMO
INTRODUCTION: This study aimed to compare the early postoperative outcomes of right anterior thoracotomy minimally invasive aortic valve replacement (RAT-MIAVR) surgery with those of median full sternotomy aortic valve replacement (MFS-AVR) approach with the goal of identifying potential benefits or drawbacks of each technique. METHODS: This retrospective, observational, cohort study included 476 patients who underwent RAT-MIAVR or MFS-AVR in our hospital from January 2015 to January 2023. Of these, 107 patients (22.5%) underwent RAT-MIAVR, and 369 patients (77.5%) underwent MFS-AVR. Propensity score matching was used to minimize selection bias, resulting in 95 patients per group for analysis. RESULTS: After propensity matching, two groups were comparable in preoperative characteristics. RAT-MIAVR group showed longer cardiopulmonary bypass time (130.24 ± 31.15 vs. 117.75 ± 36.29 minutes, P=0.012), aortic cross-clamping time (76.44 ± 18.00 vs. 68.49 ± 19.64 minutes, P=0.004), and longer operative time than MFS-AVR group (358.47 ± 67.11 minutes vs. 322.42 ± 63.84 minutes, P=0.000). RAT-MIAVR was associated with decreased hospitalization time after surgery, lower postoperative blood loss and drainage fluid, a reduced incidence of mediastinitis, increased left ventricular ejection fraction, and lower pacemaker use compared to MFS-AVR. However, there was no significant difference in the incidence of major complications and in-hospital mortality between the two groups. CONCLUSION: RAT-MIAVR is a feasible and safe alternative procedure to MFS-AVR, with comparable in-hospital mortality and early follow-up. This minimally invasive approach may be a suitable option for patients requiring isolated aortic valve replacement.
Assuntos
Valva Aórtica , Implante de Prótese de Valva Cardíaca , Humanos , Valva Aórtica/cirurgia , Esternotomia/métodos , Toracotomia/métodos , Estudos Retrospectivos , Estudos de Coortes , Pontuação de Propensão , Volume Sistólico , Implante de Prótese de Valva Cardíaca/métodos , Resultado do Tratamento , Tempo de Internação , Função Ventricular EsquerdaRESUMO
OBJECTIVE: This study investigated the relationship of the pre-operative neutrophil/lymphocyte ratio (NLR) to the timing of epidural analgesia administration and post-operative acute and chronic pain in thoracotomy. MATERIALS AND METHODS: The study was conducted on 60 patients, with NLR ≥ 2 (Group A) and NLR < 2 (Group B). Each group was divided into subgroups pre-emptive analgesia (Group P) and control group (Group C). Epidural analgesic solution was administered as a bolus before the surgical incision in Group P and at the end of the operation in Group C. NRS was questioned postoperatively at the 2nd, 4th, 8th, 12th, 24th h, 1st, and 3rd months and also additional analgesic needs were recorded. RESULTS: In Group A, the pain scores of the patients who received pre-emptive epidural analgesia were lower at the post-operative 2nd, 4th, and 8th h and analgesic consumption was less in the post-operative first 24 h. CONCLUSION: It was observed that pre-emptive epidural analgesia reduced pain levels and additional analgesic consumption in the acute post-operative period in patients with pre-operative NLR ≥ 2.
OBJETIVO: Este estudio investigó la relación de la relación neutrófilos/linfocitos (NLR) preoperatoria con el momento de la administración de la analgesia epidural y el dolor agudo y crónico posoperatorio en la toracotomía. MATERIALES Y MÉTODOS: El estudio se realizó en 60 pacientes, como NLR ≥ 2 (Grupo A) y NLR < 2 (Grupo B). Cada grupo se dividió en subgrupos de analgesia preventiva (Grupo P) y grupo control (Grupo C). La solución analgésica epidural se administró en bolo antes de la incisión quirúrgica en el Grupo P y al final de la operación en el Grupo C. La NRS se cuestionó posoperatoriamente a las 2, 4, 8, 12, 24 horas, 1 y 3 meses también adicionales Se registraron las necesidades analgésicas. RESULTADOS: En el Grupo A, los puntajes de dolor de los pacientes que recibieron analgesia epidural preventiva fueron menores a las 2, 4 y 8 horas postoperatorias y el consumo de analgésicos fue menor en las primeras 24 horas postoperatorias. CONCLUSIÓN: Se observó que la analgesia epidural preventiva redujo los niveles de dolor y el consumo adicional de analgésicos en el postoperatorio agudo en pacientes con NLR preoperatorio ≥ 2.
Assuntos
Analgesia Epidural , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Neutrófilos , Toracotomia , Analgesia Controlada pelo Paciente , Analgésicos/uso terapêutico , LinfócitosRESUMO
El sarcoma folicular de células dendríticas (SFCD) es una neoplasia maligna rara derivada de las células dendríticas foliculares. Ha sido clasificado, dadas sus características inmunohistoquímicas, como parte del grupo de los sarcomas, donde representa un porcentaje menor al 1%. Actualmente, existen menos de 1.000 reportes en la literatura a nivel mundial, lo cual plantea una dificultad no sólo diagnóstica, siendo confundido frecuentemente con neoplasias de tipo linfoide; sino también terapéutica al no existir un claro consenso sobre su manejo definitivo. Esta revisión de caso clínico describe el primer caso reportado de SFCD en Costa Rica.
Follicular dendritic cell sarcoma (SFCD) is a rare malignant neoplasm derived from follicular dendritic cells, which has been classified, given its immunohistochemical characteristics, as part of the group of sarcomas, where it represents less than 1%. Currently, there are less than 1000 reports in the literature worldwide, which generates a difficulty not only in diagnosis, being frequently confused with lymphoid type neoplasms; but also, as therapeutic as there is no clear consensus on its definitive management. This clinical case review describes the first reported case of SFCD in Costa Rica.
Assuntos
Humanos , Feminino , Adulto , Asma/diagnóstico , Tosse/diagnóstico , Sarcoma de Células Dendríticas Foliculares/diagnóstico , Neoplasias do Mediastino/diagnóstico , Obesidade/diagnóstico , Biópsia , Relatos de Casos , Diagnóstico por Imagem , Imuno-Histoquímica , Toracotomia , Costa RicaRESUMO
Thoracotomy is defined as an incision made by the surgeon in the chest wall in order to allow visibility of the thoracic cavity content. This can be used by surgeons to treat thoracic cavity content diseases including the heart, lungs, esophagus, and other organs. Thoracic incision closure remains an item with no consensus. Therefore, we present an easy way and give a little tip for closure using the slipknot that will allow the correct approach of ribs and the successful closure of the intercostal space.
Assuntos
Parede Torácica , Toracotomia , Humanos , Toracotomia/métodos , Resultado do Tratamento , Parede Torácica/cirurgia , Coração , Pulmão/cirurgiaRESUMO
A 1.5-year-old male German Shepherd dog was referred to a Teaching Veterinary Hospital with a chronic history of regurgitation and a previous presumptive diagnosis of megaesophagus. An esophagogram showed partial esophageal dilation, suggesting one vascular ring anomaly. Computed tomography identified a persistent right aortic arch (PRAA) and an aberrant left subclavian artery (ALSA). The patient underwent thoracotomy, ligamentum arteriosum ligation, and debridement of the periesophageal region. The ligation of the ALSA was not carried out because the esophagus was observed to be released entirely during the surgical intervention. Therefore, intervention on the subclavian artery was not necessary. Clinical follow-up occurred on seven, 14, and 30 postoperative days. The dog improved, showing only sporadic regurgitations. Clinical history and complementary exams were essential to establish a diagnosis. The liberation of the esophageal transit during surgery contributed to the decision not to perform the ALSA ligation.(AU)
Um cão pastor alemão, macho, de 1,5 anos de idade, foi atendido em um Hospital Veterinário Universitário com história crônica de regurgitação e diagnóstico presuntivo prévio de megaesôfago. Um esofagograma mostrou dilatação parcial do esôfago sugerindo uma anomalia de anel vascular. A tomografia computadorizada identificou persistência do arco aórtico direito (PAAD) e artéria subclávia esquerda aberrante (ALSA). O paciente foi submetido à toracotomia, ligadura do ligamento arterioso e desbridamento da região periesofágica. A ligadura da ALSA não foi realizada, pois, durante a intervenção cirúrgica, observou-se que o esôfago estava completamente liberado, não sendo necessária intervenção na artéria subclávia. O acompanhamento clínico ocorreu aos sete, 14 e 30 dias de pós-operatório. O cão evidenciou boa recuperação, apresentando apenas regurgitações esporádicas. A história clínica associada aos exames complementares foi essencial para o diagnóstico. A liberação do trânsito esofágico durante a cirurgia contribuiu para a decisão de não realizar a ligadura da ALSA.(AU)
Assuntos
Animais , Masculino , Toracotomia/veterinária , Cães , Refluxo Laringofaríngeo/diagnóstico , Anel Vascular/diagnóstico , Artéria Subclávia/anormalidadesRESUMO
Abstract Objective To comparatively analyze isolated posterior and double surgical approaches for the treatment of severe scoliosis. Methods We retrospectively analyzed medical records of 32 patients with scoliosis angular value > 70° submitted to surgical treatment in a tertiary hospital between 2009 and 2019. These patients were divided into two groups: PV group with 17 patients submitted to arthrodesis by isolated posterior route (PV) and APV group with 15 patients approached anteriorly and posteriorly (APV). In the PV group, there were 16 female patients and 1 male, with a mean age of 16.86 years old. In the APV group, there were 10 female patients and 5 males, with a mean age of 17.71 years old. Cobb angles were measured by a single spinal surgeon manually on panoramic radiographs, orthostasis before and after surgery. Weight, pre- and postoperative height, and duration of the procedure were also evaluated. Results In the PV group, preoperative and postoperative Cobb angles, verified in the main curve, were 96.06 ± 8.45° and 52.27 ± 15.18°, with an average correction rate of 0.54 ± 0.16, respectively. In the APV group, these values were 83.12 ± 11.60° for preoperative Cobb angle, and 48.53 ± 10.76° postoperatively, with correction rate of the main curve of 0.58 ± 0.11. Conclusion The two forms of surgical approach for the treatment of severe scoliosis were astowed as to the rate of correction of the deformity. Therefore, isolated posterior access has an advantage over the double approach, based on shorter surgical time, shorter hospital stay, and less risk of complications
Resumo Objetivo Analisar comparativamente as abordagens cirúrgicas por via posterior isolada e dupla abordagem para tratamento da escoliose severa. Métodos Analisou-se retrospectivamente prontuários de 32 pacientes com escoliose de valor angular > 70° submetidos a tratamento cirúrgico em hospital terciário entre 2009 e 2019. Dividiu-se estes pacientes em dois grupos: Grupo VP com 17 pacientes submetidos a artrodese por via posterior isolada (VP) e Grupo VAP com 15 pacientes abordados por via anterior e posterior (VAP). O Grupo VP apresentou 16 pacientes do sexo feminino e 1 do masculino, com idade média de 16,86 anos. No grupo VAP, 10 pacientes do sexo feminino e 5 do masculino, com idade média de 17,71 anos. Os ângulos de Cobb foram mensurados por único cirurgião de coluna, manualmente, em radiografias panorâmicas, em ortostase no pré- e pós-operatório. Foram avaliados também peso, altura pré- e pós-operatória e duração do procedimento. Resultados No Grupo VP, o ângulo de Cobb pré-operatório e pós-operatório, verificados na curva principal, foram respectivamente 96,06° ± 8,45° e 52,27 ± 15,18°, apresentando taxa média de correção de 0,54 ± 0,16. No grupo VAP, esses valores foram de 83,12° ± 11,60° para o ângulo de Cobb pré-operatório, 48,53 ± 10,76, pós-operatório, com a taxa de correção da curva principal de 0,58 ± 0,11. Conclusão As duas formas de abordagem cirúrgica para tratamento de escoliose severa se equiparam quanto à taxa de correção da deformidade. Portanto, o acesso posterior isolado apresenta vantagem em relação a dupla via, baseado no menor tempo cirúrgico, menor tempo de internação e menos risco de complicações
Assuntos
Humanos , Escoliose , Fusão Vertebral , ToracotomiaRESUMO
Introducción: Se presenta un caso clínico de sistema de presión negativa como tratamiento de ventana torácica derecha, realizado en la clínica de heridas. Se describe el tiempo y proceso de cicatrización, desde la llegada del paciente hasta la cicatrización total. Caso: Hombre de 24 años, postoperado de toracotomía, se le colocó terapia de presión negativa inicial a -75mmHg con intensidad media y modalidad continua; se aplicó esponja blanca para proteger el pulmón expuesto y esponja de plata, con tres cambios cada siete días. Posteriormente, se realizaron diez cambios de esponjas cada cuatro días, identificando disminución de las dimensiones de la ventana torácica. En la semana once inició tratamiento con terapia húmeda y fibrina rica en plaquetas, la cual se colocó en el lecho de la herida, aplicándose una vez por semana durante un mes. A partir de la semana quince se realizó curación diaria con aplicación de sulfadiazina de plata. El paciente fue dado de alta en la semana veinte con la herida 100% epitelizada. Conclusiones: El uso de la terapia de presión negativa acelera el proceso de curación, reduce las complicaciones y la carga bacteriana del tejido, debido a que la esponja de plata actúa como barrera antimicrobiana.
Introduction: A clinical case of negative pressure system as a right thoracic window treatment, performed in the wound clinic, is presented. The time and healing process from patient arrival to complete healing is described. Case: A 24-year-old man, postoperative thoracotomy, was placed on negative pressure therapy at -75mmHg with medium intensity and continuous mode; white sponge was applied to protect the exposed lung and silver sponge, with three changes every seven days. Subsequently, ten sponge changes were performed every four days, identifying a decrease in the dimensions of the thoracic window. In week eleven, the patient started treatment with wet therapy and platelet-rich fibrin, which was placed in the wound bed and applied once a week for a month. From week fifteen onwards, daily healing was performed with silver sulfadiazine application. The patient was discharged at week twenty with the wound 100% epithelialized. Conclusions: The use of negative pressure therapy accelerates the healing process, reduces complications and tissue bacterial load, due to the silver sponge acting as an antimicrobial barrier.