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1.
Pan Afr Med J ; 35: 3, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32117519

RESUMO

Introduction: The aim of this study is to compare the use of flutter valve drainage bag system as an alternative to conventional underwater seal drainage bottle in the management of non-massive malignant/paramalignant pleural effusion. Methods: Forty-one patients with non-massive malignant and paramalignant pleural effusions were randomized into two groups. Group A (21patients) had their chest tubes connected to an underwater seal drainage bottle, while group B (20 patients) had their chest tubes connected to a flutter bag drainage device. Data obtained was analyzed with SPSS statistical package (version 16.0). Results: Breast cancer was the malignancy present at diagnosis in 24(58%) patients. Complication rates were similar, 9.5% in the underwater seal group and 10 % in the flutter bag drainage group. The mean duration to full mobilization was 35.0±20.0 hours in the flutter bag group and 52.7±18.5 hours in the underwater seal group, p-value 0.007. The mean length of hospital was 7.9±2.2 days in the flutter bag group and 9.8±2.7 days in the underwater seal group. This was statistically significant, p-value of 0.019. There was no difference in the effectiveness of drainage between both groups, complete lung re-expansion was observed in 16(80%) of the flutter bag group and 18(85.7%) of the underwater seal drainage group, p-value 0.70. Conclusion: The flutter valve drainage bag is an effective and safe alternative to the standard underwater seal drainage bottle in the management of non-massive malignant and paramalignant pleural effusion.


Assuntos
Drenagem/métodos , Derrame Pleural Maligno/terapia , Derrame Pleural/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tubos Torácicos , Drenagem/efeitos adversos , Drenagem/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/fisiopatologia , Derrame Pleural Maligno/fisiopatologia , Fatores de Tempo , Adulto Jovem
3.
Zentralbl Chir ; 145(1): 108-120, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32097982

RESUMO

The therapy of severely injured patients is demanding and promising only in an interdisciplinary context. From a thoracic surgical perspective, the blunt chest trauma is in the foreground; as it is the 2nd leading cause of death after traumatic brain injury. The first step is to identify the potentially life-threatening injury and its treatment (airway obstruction, prevention of gas exchange, tension pneumothorax, serious bleeding complications in lung-/vascular injuries). Pneumothorax or tension pneumothorax is present in 20% of all polytrauma patients and 50% of all patients with severe chest trauma. In most cases, the use of a chest tube is sufficient in the acute phase (90%). For complex injuries with persistent thoracic haemorrhage and haemodynamic instability of the patient or pleural fistulization with increasing skin emphysema, surgical treatment should be performed at an early interval. Nevertheless, emergency thoracotomy is rarely required at this early stage.


Assuntos
Traumatismo Múltiplo , Pneumotórax , Traumatismos Torácicos , Ferimentos não Penetrantes , Tubos Torácicos , Humanos , Traumatismos Torácicos/cirurgia , Procedimentos Cirúrgicos Torácicos
4.
N Engl J Med ; 382(5): 405-415, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-31995686

RESUMO

BACKGROUND: Whether conservative management is an acceptable alternative to interventional management for uncomplicated, moderate-to-large primary spontaneous pneumothorax is unknown. METHODS: In this open-label, multicenter, noninferiority trial, we recruited patients 14 to 50 years of age with a first-known, unilateral, moderate-to-large primary spontaneous pneumothorax. Patients were randomly assigned to immediate interventional management of the pneumothorax (intervention group) or a conservative observational approach (conservative-management group) and were followed for 12 months. The primary outcome was lung reexpansion within 8 weeks. RESULTS: A total of 316 patients underwent randomization (154 patients to the intervention group and 162 to the conservative-management group). In the conservative-management group, 25 patients (15.4%) underwent interventions to manage the pneumothorax, for reasons prespecified in the protocol, and 137 (84.6%) did not undergo interventions. In a complete-case analysis in which data were not available for 23 patients in the intervention group and 37 in the conservative-management group, reexpansion within 8 weeks occurred in 129 of 131 patients (98.5%) with interventional management and in 118 of 125 (94.4%) with conservative management (risk difference, -4.1 percentage points; 95% confidence interval [CI], -8.6 to 0.5; P = 0.02 for noninferiority); the lower boundary of the 95% confidence interval was within the prespecified noninferiority margin of -9 percentage points. In a sensitivity analysis in which all missing data after 56 days were imputed as treatment failure (with reexpansion in 129 of 138 patients [93.5%] in the intervention group and in 118 of 143 [82.5%] in the conservative-management group), the risk difference of -11.0 percentage points (95% CI, -18.4 to -3.5) was outside the prespecified noninferiority margin. Conservative management resulted in a lower risk of serious adverse events or pneumothorax recurrence than interventional management. CONCLUSIONS: Although the primary outcome was not statistically robust to conservative assumptions about missing data, the trial provides modest evidence that conservative management of primary spontaneous pneumothorax was noninferior to interventional management, with a lower risk of serious adverse events. (Funded by the Emergency Medicine Foundation and others; PSP Australian New Zealand Clinical Trials Registry number, ACTRN12611000184976.).


Assuntos
Tratamento Conservador , Drenagem , Pneumotórax/terapia , Adolescente , Adulto , Tubos Torácicos , Drenagem/métodos , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Pneumotórax/diagnóstico por imagem , Complicações Pós-Operatórias , Radiografia Torácica , Recidiva , Resultado do Tratamento , Conduta Expectante , Adulto Jovem
5.
J Stroke Cerebrovasc Dis ; 29(2): 104495, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31806453

RESUMO

BACKGROUND AND AIM: Accurate anesthesia management is of great importance for the success of interventional neuroangiographic procedures (INPs). General anesthesia with endotracheal intubation is the most commonly preferred anesthetic method for these procedures. However, whether laryngeal mask airway (LMA) anesthesia is a suitable and safe option for such cases is unclear. The aims of this study were to report the outcomes of anesthetic management in patients who underwent INP, and to compare endotracheal intubation with LMA anesthesia in terms of anesthesia-related outcomes. METHODS: Data of patients who underwent INP under general anesthesia at interventional neuroangiography unit were retrospectively evaluated. RESULTS: A total of 105 patients with a mean age of 52.9 years were included in the study. All procedures were performed under general anesthesia with using endotracheal tube (n = 79, 75.2%) or laryngeal mask (n = 26, 24.8%). Anesthesia-related complications, including respiratory (laryngospasm,bronchospasm, and desaturation) and circulatory (disrhythmia, hypotension, hypertension), were observed in 20 (19.1%) patients. The 2 airway instruments were similar in age, gender, diagnosis, American Society of Anesthesiologist score, mallampati score, duration of procedure, and duration of anesthesia (P > .05). Anesthesia-related complications were more common in LMA group compared with patients who were intubated using endotracheal tube (P = .003). CONCLUSIONS: Anesthesia management in INPs carries many challenges for anesthesiologists, due to the need of exact immobility during the procedure and potential procedure-related risks such as vasculary perforation and bleeding. General anesthesia using endotracheal intubation seems to be more secure, in comparison to LMA anesthesia.


Assuntos
Anestesia Geral/instrumentação , Transtornos Cerebrovasculares/terapia , Tubos Torácicos , Procedimentos Endovasculares , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Radiografia Intervencionista , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Transtornos Cerebrovasculares/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
6.
Einstein (Sao Paulo) ; 18: eAO4409, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31618286

RESUMO

OBJECTIVE: To compare the chest tube drainage by the same thoracotomy intercostal space with the traditional approach in patients undergoing muscle-sparing thoracotomy. METHODS: We evaluated 40 patients aged ≥18 years who underwent elective muscle sparing thoracotomies. Patients were divided into two groups of 20 patients. One group underwent thoracic drainage by the same intercostal space of thoracotomy and the other by traditional chest drainage approach. RESULTS: The mean length of hospital stay for the intercostal drainage group in the intensive care unit was 1.5 day (1.0 to 2.0 days) and 2.0 days (25.1 to 3.0 days) for the traditional chest drainage group (p=0.060). The intercostal drainage group had mean length of hospital stay (p=0.527) and drainage (p=0.547) of 4 days, and the traditional chest drainage group and 2 and 5.5 days, respectively. Dipirona and tramadol doses did not differ between groups (p=0.201 and p=0.341). The mean pain scale values on first postoperative was 4.24 in the drainage by the same intercostal group and 3.95 in the traditional chest drainage (p=0.733). In third postoperative day, mean was 3.18 for the first group and 3.11 for the traditional group (p=0.937). In the 15th day after surgery, drainage by the incision was 1.53 and the traditional chest drainage was 2.11 (p=0.440), 30th days after drainage by incision was 0.71 and traditional chest drainage was 0.84 (p=0.787). Complications, for both groups were similar with 30% in proposed drainage and 25% in traditional approach (p=0.723). CONCLUSION: Drainage by the same thoracotomy intercostal space was feasible and results 30 days after surgery were not inferior to those of the traditional chest drainage approach.


Assuntos
Tubos Torácicos , Drenagem/métodos , Toracotomia/métodos , Analgesia Epidural , Analgésicos/uso terapêutico , Fibrilação Atrial/etiologia , Dipirona/uso terapêutico , Drenagem/estatística & dados numéricos , Dispneia/etiologia , Humanos , Tempo de Internação , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Período Pós-Operatório , Estudos Prospectivos , Toracotomia/efeitos adversos , Tramadol/uso terapêutico
7.
J Cardiothorac Surg ; 14(1): 192, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703606

RESUMO

BACKGROUND: Chest tubes are routinely used to evacuate shed mediastinal blood in the critical care setting in the early hours after heart surgery. Inadequate evacuation of shed mediastinal blood due to chest tube clogging may result in retained blood around the heart and lungs after cardiac surgery. The objective of this study was to compare if active chest tube clearance reduces the incidence of retained blood complications and associated hospital resource utilization after cardiac surgery. METHODS: Propensity matched analysis of 697 consecutive patients who underwent cardiac surgery at a single center. 302 patients served as a baseline control (Phase 0), 58 patients in a training and compliance verification period (Phase 1) and 337 were treated prospectively using active tube clearance (Phase 2). The need to drain retained blood, pleural effusions, postoperative atrial fibrillation, ICU resource utilization and hospital costs were assessed. RESULTS: Propensity matched patients in Phase 2 had a reduced need for drainage procedures for pleural effusions (22% vs. 8.1%, p < 0.001) and reduced postoperative atrial fibrillation (37 to 25%, P = 0.011). This corresponded with fewer hours in the ICU (43.5 [24-79] vs 30 [24-49], p = < 0.001), reduced median postoperative length of stay (6 [4-8] vs 5 [4-6.25], p < 0.001) median costs reduced by $1831.45 (- 3580.52;82.38, p = 0.04) and the mean costs reduced by an average of $2696 (- 6027.59;880.93, 0.116). CONCLUSIONS: This evidence supports the concept that efforts to actively maintain chest tube patency in early recovery is useful in improving outcomes and reducing resource utilization and costs after cardiac surgery. TRIAL REGISTRATION: Clinicaltrial.gov, NCT02145858, Registered: May 23, 2014.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Tubos Torácicos , Drenagem/métodos , Custos Hospitalares/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Idoso , Drenagem/economia , Drenagem/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Hampshire , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
8.
Kyobu Geka ; 72(10): 834-839, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31582705

RESUMO

The proper management of chest tubes for patients undergoing lung resection is very important to prevent postoperative complications. Although it is desired to have evidence-based consensus for the management of chest tubes, currently the protocols vary among institutions. This article reviewed some recent literatures and our opinions regarding postoperative management of chest tubes. The use of 1 chest tube has been recently preferred compared to 2 chest tubes. However, the use of 2 chest tubes are required when postoperative air leakage, massive fluid discharge, or hemorrhage is concerned after peeling the firm and broad range of pleural adhesions. The chest tube is inserted through the skin incision through an access port and upper edge of the rib at an intercostal space from the skin incision, and then, commonly attached to the chest drainage unit employing a 3-bottle system. Although continuous suction with water sealing is usually utilized, a randomized controlled trial revealed that continuous suction was not better than water sealing without suction in terms of duration of air leakage, chest drainage, and hospital stay. Chest tubes can be safely removed with both no air leakage during coughing as well as daily drainage volume of up to 200 ml. According to a systematic review and meta-analysis, recently developed digital chest drainage system, with which the pleural pressure can be constantly maintained and air leakage can be evaluated objectively, proved to reduce the risk of prolonged air leakage and to shorten the duration of chest drainage and hospital stay after lung resection when compared with the traditional analog drainage system. Prolonged postoperative air leakage is usually treated with chemical pleurodesis using autologous blood, minocycline, or OK -432. Some studies demonstrated that pleurodesis with 50% glucose solution was a safe and effective treatment option.


Assuntos
Tubos Torácicos , Pneumonectomia , Drenagem , Humanos , Complicações Pós-Operatórias , Sucção
9.
Heart Surg Forum ; 22(5): E352-E356, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31596710

RESUMO

BACKGROUND: The association of obesity with postoperative bleeding volume and transfusions after coronary artery bypass grafting (CABG) is not clear. We evaluated the effects of body mass index (BMI) on bleeding volume and transfusions in patients undergoing on-pump CABG. METHODS: We investigated 1,050 patients, aged 24 years to 83 years, who underwent isolated, primary CABG with cardiopulmonary bypass (CPB) at Fuwai Hospital, Chinese Academy of Medical Sciences, from September 2017 to July 2018. We recorded preoperative medical and laboratory coagulation parameters, intraoperative data, and postoperative bleeding volume for 24 hours following surgery. Primary endpoint was bleeding volume within 24 hours and transfusions after surgery. We analyzed the correlation between bleeding volume within 24 hours and transfusions after surgery and preoperative data with univariate and multivariate linear regression and logistic regression. RESULTS: Old age significantly increased postoperative transfusions (OR = 1.035 95% CI 1.013-1.058, P = .002), whereas higher BMI (OR = 0.897 95% CI 0.848-0.949, P < .001) and higher hemoglobin (HGB) (OR = 0.966 95% CI 0.954-0.978, P < 0.001) decreased postoperative transfusions. And, BMI independently was correlated with bleeding volume after multivariate regression analysis (B = -0.257, P < .001). CONCLUSIONS: Our findings suggest higher BMI may reduce postoperative bleeding volume and transfusion rate, thus such patients may save blood products during on-pump CABG.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Índice de Massa Corporal , Ponte Cardiopulmonar , Ponte de Artéria Coronária/métodos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Coagulação Sanguínea , Volume Sanguíneo , Tubos Torácicos , Drenagem , Feminino , Hemoglobina A/análise , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
10.
Acute Med ; 18(3): 200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536060

RESUMO

Cama et al's review of pneumothorax management was excellent, especially their elegant depiction of chest tube diameter in comparison to the intercostal space, as measured in French gauge. The use of gauge is medicine is confusing due to differing systems and seemingly random increments. This diagram neatly shows that French gauge (Fr) is directly proportional to diameter, as the external diameter of the tube in millimetres is the gauge multiplied by three. For example, a 15 Fr chest tube has an external diameter of 5mm.


Assuntos
Tubos Torácicos , Pneumotórax , Humanos
11.
J Med Case Rep ; 13(1): 283, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31495337

RESUMO

BACKGROUND: Primary spontaneous pneumothorax is a common disorder occurring in young adults without underlying lung disease. Although tobacco smoking is a well-documented risk factor for spontaneous pneumothorax, an association between electronic cigarette use (that is, vaping) and spontaneous pneumothorax has not been noted. We report a case of spontaneous pneumothoraces correlated with vaping. CASE PRESENTATION: An 18-year-old Caucasian man presented twice with recurrent right-sided spontaneous pneumothoraces within 2 weeks. He reported a history of vaping just prior to both episodes. Diagnostic testing was notable for a right-sided spontaneous pneumothorax on chest X-ray and computed tomography scan. His symptoms improved following insertion of a chest tube and drainage of air on each occasion. In the 2-week follow-up visit for the recurrent episode, he was asymptomatic and reported that he was no longer using electronic cigarettes. CONCLUSIONS: Providers and patients should be aware of the potential risk of spontaneous pneumothorax associated with electronic cigarettes.


Assuntos
Pneumotórax/etiologia , Vaping/efeitos adversos , Adolescente , Tubos Torácicos , Drenagem , Humanos , Masculino , Pneumotórax/terapia , Recidiva
12.
G Chir ; 40(3): 170-173, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484004

RESUMO

INTRODUCTION: Prolonged air leak (PAL) is one of the most common postoperative complications after lung surgery. It is associated with increased significant morbidity, lower quality of life, longer hospital stay and higher hospital costs. Since its great clinical and economic burden, it is important to establish the feasibility and the effectiveness of the routinary preventive use of a fibrin sealant in order to reduce the incidence of prolonged air leaks. PATIENTS AND METHODS: This is a randomized study on 189 adult patients - 118 men (62.4%) and 71 women (37.6%) aged from 39 to 87 y.o. (mean age 68.3 y.o.) - who underwent lung surgery (lobectomy or bilobectomy) with intraoperatory detection of air leakage, from January 2013 to December 2017, at Department of Thoracic Surgery in "Ospedale Maggiore Carlo Alberto Pizzardi" (Bologna, Italy) and Department of Thoracic Surgery in "Paolo Giaccone" Teaching Hospital (Palermo, Italy). Patients were randomly assigned to the "Glue" arm (90 patients) or the "Control" group (99 patients). We only used stapler or manual suture to achieve aerostasis. In addition, we used a fibrin sealant ("glue") to cover the suture line on patients in the "Glue" arm. The primary endpoints were incidence of prolonged air leaks, days with chest tube and mean hospital stay. RESULTS: In the "Glue" arm we experienced only 1 prolonged air leak (1.1%), while in the "Control" group there were 8 leaks (8.1%). Patients kept chest tube for average 4.15 days in the "Glue" arm and 4.45 days in the "Control" group. The mean hospital stay was average 7.4 days for the "Glue" arm, while 9.1 days in the "Control" group. CONCLUSIONS: According to our experience it seems that the routinary preventive use of a fibrin sealant results in a lower incidence of prolonged air leaks, a shorter hospital stay with lower hospital costs, representing a cost-effective, feasible and effective system to decrease morbility and mortality among surgical patients.


Assuntos
Ar , Fístula Anastomótica/prevenção & controle , Adesivo Tecidual de Fibrina/uso terapêutico , Pneumonectomia/efeitos adversos , Adesivos Teciduais/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Tubos Torácicos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Qualidade de Vida , Técnicas de Sutura
15.
Pediatr Cardiol ; 40(8): 1609-1617, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31468062

RESUMO

Postoperative prolonged pleural effusion (PPE) remains a confounding problem after a Fontan operation. We aimed to describe the risk factors for PPE after a Fontan operation and to clarify the impact of prophylactic opening of the pleural cavity (POPC) for drainage tube insertion on PPE. We retrospectively reviewed the medical charts of 50 consecutive patients who underwent a Fontan operation at our institution. POPC for postoperative drainage was performed based on each surgeon's preference. Patients were divided into three groups for analysis: group A (n = 12), no opening; group B (n = 14), unilateral opening; and group C (n = 24), bilateral opening. At the time of surgery, the median age of our patient group was 26 months, with a median body weight of 10.5 kg. The volume of pleural effusion tended to be lower in group A than in groups B and C (p = 0.08). The median duration of drainage was significantly shorter (p = 0.03) in group A (3 days) than in group B (4 days) or C (5 days). Overall, 12 patients required chest tube drainage for ≥ 7 days. Multivariate analysis revealed POPC (p = 0.01) and postoperative water balance (p = 0.03) as independent predictors of PPE. POPC and postoperative water balance are risk factors for PPE after a Fontan operation. Therefore, avoiding POPC for postoperative drainage may reduce the risk of postoperative pleural effusion and morbidities associated with PPE after a Fontan operation.


Assuntos
Drenagem/efeitos adversos , Técnica de Fontan/efeitos adversos , Cavidade Pleural/cirurgia , Derrame Pleural/etiologia , Estudos de Casos e Controles , Tubos Torácicos/efeitos adversos , Pré-Escolar , Drenagem/métodos , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Medicine (Baltimore) ; 98(26): e15857, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261493

RESUMO

Drainage of the thorax postoperatively using chest tubes is a standard procedure in thoracic surgery. However, chest tubes can induce pain and immobilization, increase risk of infection, deteriorate the ventilation capacity, and increase difficulty of postoperative management, particularly in children. This study aimed to investigate the safety and effect of excluding chest tubes after performing thoracoscopic lobectomy in selected children.A retrospective review of medical records was performed in West China Hospital of Sichuan University from January 2014 to June 2018. Patients who underwent thoracoscopic lobectomy without chest tubes were recorded. Patients with accompanying severe pulmonary infection, extensive thoracic adhesions, or undeveloped interlobar fissure were excluded.In total, 246 patients underwent thoracoscopic lobectomy without a chest tube, and none required chest drain insertion or reintervention during hospitalization and follow-up at 90 days postoperatively. Among them, 2 (0.81%) patients developed a delayed pneumothorax which was found after being discharged, and resolved spontaneously in 2 weeks. No hemothorax, atelectasis, and bronchial fistula were found. Furthermore, 202 (82.1%) patients developed subcutaneous emphysema, which was asymptomatic and spontaneously resolved within 3 to 7 days. The length of postoperative hospital stay was 2 days; patients were discharged in the 3rd day postoperatively. Patients could recover to free mobilization and resume regular diet at 6 hours postoperatively. All patients were followed up for at least 3 months; no other complications were found, and all patients recovered well.This study showed that chest tube placement in selected patients may be unnecessary in children undergoing thoracoscopic lobectomy. The minimally invasive procedure and meticulous resection have been the preconditions of this procedure, which may contribute to a rapid recovery and can avoid the chest tube-related complications effectively.


Assuntos
Tubos Torácicos , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Drenagem/instrumentação , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Duração da Cirurgia , Segurança do Paciente , Pneumonectomia/instrumentação , Pneumonectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/instrumentação , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
18.
BMJ Case Rep ; 12(7)2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31326914

RESUMO

A 35-year-old man was admitted in the emergency department with a complaint of progressive dyspnoea and 4-day prior history of a road traffic accident. An initial evaluation was inconspicuous and he was discharged. Clinical examination and radiological imaging suggested bilateral pleural effusion for which bilateral intercostal drains were inserted. Further pleural fluid analysis aided the diagnosis of bilateral chylothorax. A conservative approach consisting of a fat-free diet, total parenteral nutrition and octreotide therapy was started. Upon failure of conservative management, thoracic duct ligation by thoracotomy was done. Chylous output decreased dramatically and subsequently, and the patient was discharged in a healthy condition. This case illustrates intricacies involved in the diagnosis and management of traumatic chylothorax. Also, conservative treatment forms the first line of management, but if ineffective, then early surgical intervention should be considered. Early diagnosis and timely intervention are keystone factors for a better outcome.


Assuntos
Quilotórax/cirurgia , Derrame Pleural/cirurgia , Ducto Torácico/cirurgia , Traumatismos Torácicos/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Acidentes de Trânsito , Adulto , Tubos Torácicos , Quilotórax/diagnóstico por imagem , Diagnóstico Diferencial , Drenagem , Humanos , Ligadura , Masculino , Derrame Pleural/diagnóstico por imagem , Traumatismos Torácicos/complicações , Toracotomia , Tomógrafos Computadorizados , Ferimentos não Penetrantes/complicações
19.
Medicine (Baltimore) ; 98(29): e16599, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335742

RESUMO

Chylothorax after lobectomy is common, lacking reliable preventive measures. Octreotide is widely used for treatment of chyle leakage, but its role in preventing chylothorax has not been estimated. The aim of this study was to evaluate whether prophylactic octreotide could reduce the incidence of postoperative chylothorax.Patients who underwent lobectomy for lung cancer from January 2016 to September 2018 were retrospectively reviewed. The cases in prophylactic group received octreotide 1 day before the surgery until removal of chest tubes, while those in the control group did not use it unless the diagnosis of chylothorax.A total of 379 patients were enrolled, with 190 patients in control and 189 cases in prophylactic group. Octreotide was well tolerated in patients who received this agent. No 30-day mortality was indicated. Seven cases in control (3.7%, 7/190) and 3 cases in prophylactic group (1.6%, 3/189) with chylothorax were observed (P = .337). The patients in prophylactic group showed shorter duration of chest drainage ([3.6 ±â€Š1.6] days vs [4.1 ±â€Š2.0] days, P = .006) and reduced drainage volume ([441.8 ±â€Š271.1] mL vs [638.7 ±â€Š463.3] mL, P < .001). In addition, they showed similar stations and numbers of dissected lymph nodes, surgery-related complications, and postoperative hospital stay. Besides, 11 (5.8%, 11/190) patients in control and 6 (3.2%, 6/189) cases in the prophylactic group were readmitted for pleural effusion needing reinsertion of chest tubes (P = .321). Moreover, multivariable logistic analysis showed that induction therapy (odds ratio [OR] =12.03; 95% confidence interval [CI] 3.15-46.03, P < .001) was a risk factor, while high-volume experience of the surgeon (OR = 0.23; 95% CI 0.06-0.97, P = .045) was a preventive factor of surgery-related chylothorax. Additionally, prophylactic octreotide (OR = 0.18; 95% CI 0.11-0.28, P < .001) and perioperative low-fat diet (OR = 0.46; 95% CI 0.29-0.73, P = .001) were negatively associated with the drainage volume of pleural effusion. Furthermore, high-volume experience of the surgeon (OR = 6.03; 95% CI 1.30-27.85, P = .021) and induction therapy (OR = 8.87; 95% CI 2.97-26.48, P < .001) were risk factors of unplanned readmission.Prophylactic octreotide does not reduce the incidence of postoperative chylothorax or unplanned readmission following anatomic lobectomy. The routine application of octreotide should not be recommended. High-quality trials are required to validate these findings.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Quilotórax/prevenção & controle , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Octreotida/uso terapêutico , Pneumonectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Tubos Torácicos , Quilotórax/etiologia , Dieta com Restrição de Gorduras , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Derrame Pleural , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
20.
BMJ Case Rep ; 12(7)2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31300601

RESUMO

This is a rare case of sporadic lymphangioleiomyomatosis (S-LAM) manifesting as refractory chylothorax and chyloperitoneum. A middle-aged woman with unremarkable medical history presented with respiratory failure, abdominal distension and anasarca. She was found to have high-output chylous effusion that required chest tube drainage, as well as chylous ascites. Notably initial chest and abdominal CT did not reveal characteristic pulmonary cysts or the presence of angiomyolipomas suggestive of LAM. An extensive oncologic and infectious work-up was undertaken with negative findings. The chylous effusion was persistent and refractory to thoracic duct embolization, total parenteral nutrition with octreotide, and talc pleurodesis. Diagnosis of S-LAM was confirmed after repeat chest CT showed subtle pulmonary cystic changes, and serum vascular endothelial growth factor-D level was found to be elevated at 834 pg/mL. Patient was started on sirolimus therapy, but lost to follow-up after hospital discharge. Patient died approximately 1 year later.


Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Quilotórax/diagnóstico , Linfangioleiomiomatose/diagnóstico , Insuficiência Respiratória/patologia , Sirolimo/uso terapêutico , Ducto Torácico/patologia , Tubos Torácicos , Quilotórax/fisiopatologia , Quilotórax/terapia , Drenagem , Edema , Evolução Fatal , Feminino , Humanos , Linfangioleiomiomatose/fisiopatologia , Linfangioleiomiomatose/terapia , Pessoa de Meia-Idade , Nutrição Parenteral Total , Insuficiência Respiratória/diagnóstico por imagem
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