Simultaneous thoracoscopic approach in a patient with long-standing persistent atrial fibrillation and primary lung cancer: the first described case

Abstract Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.

Combined off-pump coronary artery bypass grafting and lung resection in patients with lung cancer accompanied by coronary artery disease

Abstract Introduction: Optimal surgical approach for the treatment of resectable lung cancer accompanied by coronary artery disease (CAD) remains a contentious issue. In this study, we present our cases that were operated simultaneously for concurrent lung cancer and CAD. Methods: Simultaneous off-pump coronary artery bypass surgery (OPCABG) and lung resection were performed on 10 patients in our clinic due to lung cancer accompanied by CAD. Demographic features of patients, operation data and postoperative results were evaluated retrospectively. Results: Mean patient age was 63.3 years (range 55-74). All patients were male. Six cases of squamous cell carcinoma, three of adenocarcinoma and one case of large cell carcinoma were diagnosed. Six patients had single-vessel CAD and 4 had two-vessel CAD. Three patients underwent OPCABG at first and then lung resection. The types of resections were one right pneumonectomy, three right upper lobectomies, one right lower lobectomy, three left upper lobectomies, and two left lower lobectomies. Reoperation was performed in one patient due to hemorrhage. One patient developed intraoperative contralateral tension pneumothorax. One patient died due to acute respiratory distress syndrome at the early postoperative period. Conclusion: Simultaneous surgery is a safe and reliable option in the treatment of selected patients with concurrent CAD and operable lung cancer.

Electrocauterio y broncoscopia flexible como primera medida en la obstrucción central de la vía aérea y hemoptisis asociada / Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis

Background: Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. Aim: To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. Material and Methods: A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. Results: Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. Conclusions: Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

Detección precoz de cáncer pulmonar con tomografía computarizada de tórax en pacientes con enfermedad pulmonar obstructiva crónica tabáquica / Early detection of lung cancer using computed tomography among patients with chronic obstructive pulmonary disease

Background: Chest computed tomography (CT) scan may improve lung cancer detection at early stages in high risk populations. Aim: To assess the diagnostic performance of chest CT in early lung cancer detection in patients with chronic obstructive pulmonary disease (COPD). Patients and Methods: One hundred sixty one patients aged 50 to 80 years, active or former smokers of 15 or more pack-years and with COPD were enrolled. They underwent annual respiratory functional assessment and chest computed tomography for three years and were followed for five years. Results: Chest CT allowed the detection of lung cancer in nine patients (diagnostic yield: 5.6%). Three cases were detected in the initial CT and six cases in follow-up scans. Most patients were in early stages of the disease (6 stage Ia and 1 stage Ib). Two patients were diagnosed at advanced stages of the disease and died due to complications of cancer. Two thirds of patients had nonspecific pulmonary nodules on the initial chest CT scan (100 patients, 62%). Seventy four percent had less than three nodules and were of less than 5 mm of diameter in 57%. In 92% of cases, these were false positive findings. In the follow-up chest CT, lung nodules were detected in two thirds of patients and 94% of cases corresponded to false positive findings. Conclusions: Chest CT scans may detect lung cancer at earlier stages in COPD patients.

Câncer do pulmão e DPOC / Lung Cancer in COPD

A DPOC e o câncer do pulmão são duas doenças fatais. Há na literatura dados que demonstra muma incidência crescente do câncer do pulmão em pacientes portadores de DPOC. Cada vez mais se aponta para um mecanismo fisiopatológico comum para as duas enfermidades. A inflamação crônica da DPOC parece desempenhar um papel significativo no desenvolvimentodo câncer do pulmão. Este artigo descreve aspectos relacionados com a incidência, mecanismos de associação e opções terapêuticas para o câncer de pulmão em portadores de DPOC

Lung cancer and COPD are common diseases, and both are fatal. Data in the literature demonstrate that the incidence of lung cancer is on the rise among COPD patients. There is increasing evidence that the two diseases share a common patho-physiology. The chronic inflammation associated with COPD appears to play a role in the development of lung cancer. This review describes aspects of the incidence of lung cancer in COPD, as well as the mechanistic links between the two diseases, together with treatment options and outcomes.

Associação entre paracoccidioidomicose e câncer / Association between paracoccidioidomycosis and cancer

OBJETIVO: Analisar a associação entre paracoccidioidomicose (Pcm) e câncer e realizar uma revisão da literatura sobre esse tópico. MÉTODOS: Revisão retrospectiva de 25 casos diagnosticados com Pcm e câncer, extraídos de uma série de 808 casos consecutivos de pacientes adultos diagnosticados com Pcm com base nos testes realizados no Laboratório de Micologia da Santa Casa Complexo Hospitalar de Porto Alegre (RS), entre 1972 e 2007. O diagnóstico de Pcm foi confirmado através de exame microscópico direto, exame histopatológico ou imunodifusão. Todos os casos de câncer foram confirmados por exame histopatológico ou citopatológico. RESULTADOS: Sintomas respiratórios foram as principais queixas dos pacientes. O envolvimento pulmonar foi o achado mais predominante, seguido pelo tegumentar e linfático. O tipo de tumor mais prevalente foi o carcinoma brônquico, em 15 casos, seguido de outros tipos de carcinoma, e 1 paciente apresentou linfoma de Hodgkin. Em 16 pacientes (64 por cento), o sítio de Pcm era o mesmo do tumor. Na maioria dos casos, o tratamento de Pcm consistiu na administração isolada de sulfanilamida, sulfametoxazol-trimetoprim, cetoconazol, itraconazol ou anfotericina B. A cirurgia foi o tratamento mais comum para o câncer, seguida de radioterapia e quimioterapia. Dos 25 pacientes, 12 foram curados para Pcm, e 4 faleceram. Em 9, o desfecho final era desconhecido. A prevalência de câncer de pulmão na população geral na área em estudo foi significativamente maior em fumantes com Pcm que em fumantes sem Pcm (p < 0,001). CONCLUSÕES: .O diagnóstico de Pcm parece aumentar o risco de câncer de pulmão.

OBJECTIVE: To analyze the association between paracoccidioidomycosis (Pcm) and cancer in a series of 25 cases and to review the literature on this topic. METHODS: A retrospective review of 25 cases diagnosed with Pcm and cancer, retrieved from a series of 808 consecutive adult patients diagnosed with Pcm based on tests conducted in the Mycology Laboratory of the Santa Casa Complexo Hospitalar, in the city of Porto Alegre, Brazil, between 1972 and 2007. The diagnosis of Pcm was confirmed by means of direct microscopic examination, histopathological examination or immunodiffusion test. All cancer cases were confirmed by histopathological or cytopathological examination. RESULTS: Respiratory symptoms were the principal complaints of the patients evaluated. Pulmonary involvement predominated, followed by skin and lymph node involvement. The most prevalent tumor was bronchial carcinoma, in 15 patients, followed by other types of carcinoma, and 1 patient had Hodgkin's lymphoma. In 16 patients (64 percent), the site of the Pcm was the same as that of the tumor. In most cases, Pcm treatment consisted of the isolated administration of sulfanilamide, sulfamethoxazole-trimethoprim, ketoconazole, itraconazole or amphotericin B. The most common treatment for cancer was surgery, followed by radiotherapy and chemotherapy. Of the 25 patients, 12 were cured of Pcm, and 4 died. In 9 patients, the final outcome was unknown. In the general population of the area under study, the prevalence of lung cancer was significantly higher in smokers with Pcm than in smokers without Pcm (p < 0.001). CONCLUSIONS: A diagnosis of Pcm appears to increase the risk of lung cancer.

Trombose venosa profunda dos membros superiores e adenocarcinoma brônquico. Relato de caso / Venous thrombosis of the upper limbs and adenocarcinoma bronchogenic. Case report

JUSTIFICATIVA E OBJETIVOS: Trombose venosa pro­funda aguda (TVP) é a oclusão de veia ocasionada por trombo, seguida de reação inflamatória na parede do vaso. O objetivo deste estudo foi relatar um caso de TVP nos membros superiores associada à câncer pulmonar, uma vez que ela afeta cerca de 800.000 pacientes por ano. RELATO DO CASO: Paciente do sexo masculino, 62 anos, pedreiro, admitido na Santa Casa de Belo Horizonte para avaliação da necessidade de cirurgia de hérnia inguinal bi­lateral. Entretanto, encontrava-se com importante aumen­to do volume do braço direito, além de tosse. Ao exame físico apresentava-se com edema (mais mais mais/4), calor e rubor no membro superior direito (MSD). Pulso radial palpável. Li­mitação parcial dos movimentos do MSD. Empastamento na região supraclavicular direita. O paciente foi internado com provável diagnóstico de trombose venosa profunda no MSD de etiologia a ser esclarecida. CONCLUSÃO: O Duplex scan venoso no MSD evidenciou processos trombóticos oclusivos recentes. O diagnóstico concluído foi trombose venosa profunda recente no mem­bro superior direito. A TVP de membros superiores possui morbidade considerável, uma vez que a embolia pulmonar está presente em até um terço dos pacientes. As principais complicações da TVP são: dor, edemas persistentes, síndro­me da veia cava superior, complicações ao acesso venoso, tromboflebite superficial, hipertensão venosa crônica e os sintomas incapacitantes recorrentes, que ocorrem em 33% a 85% dos pacientes tratados apenas com anticoagulação e elevação do membro. O tratamento desta doença é estimado a 1 - 2,5 bilhões de dólares por ano, além de estar associada à sequelas permanente. Por isso, a importância em se diagnosticá-la precocemente para que o tratamento possa ser instituído o mais breve possível.