[Ebstein's anomaly associated with ventricular septal defect. A case report]. / Anomalia de Ebstein associada a comunicação interventricular. Relato de caso.

The authors report a case of Ebstein's anomaly associated to a ventricular septal defect. It is a rare association which leads to a poor prognosis of the disease. They emphasize the clinical findings and the complementary data that lead to the definite diagnosis.

[Surgical treatment of right ventricular fibroma in infants. Report of 2 cases]. / Tratamento cirúrgico de fibroma de ventrículo direito em lactentes. Relato de dois casos.

Two patients under 8 months of age, with right ventricular fibroma, presented with clinical manifestations of pulmonary stenosis. The diagnosis was established in one by echocardiography and in the other by echocardiography. CT scan and angiocardiographic study. The patients were operated and the tumors were successfully resected.

[Results of replacement of ascending aorta, and aortic valve with reimplantation of coronary arteries]. / Resultados da substituição da aorta ascendente e valva aórtica com reimplante de artérias coronárias.

PURPOSE: To analyse a 10-year experience with the Bentall and De Bono technique for surgical treatment of aneurysms of ascending aorta. PATIENTS AND METHODS: From January 1980 to December 1989, the Bentall and De Bono technique was employed in 38 patients. Twenty-two patients had aneurysm of ascending aorta with aortic insufficiency; 14 had chronic aortic dissections. Four patients were operated on previously by other techniques. RESULTS: The immediate mortality was 5.2%; one patient due to low-output syndrome and one had neurological complications. Five patients (13.1%) died late postoperatively. The surviving 31 patients were followed up from two to 72 months (mean 25). Of these, 29 (93.5%) were in functional class I and two in class II. Sixteen patients had late evaluation by one or more of the following methods: digital angiography, chest computerized tomography, echocardiography, or conventional angiography, 6 to 60 (mean 33) months after operation. All of them had good conditions of composite valve graft and coronary artery reattachment. The immediate and late results were similar in patients with aneurysms and aortic dissections. CONCLUSION: The aortic valve and aortic ascending portion replacement with reimplantation of coronary arteries is of low mortality and fairly good late outcome.

[Intra-abdominal pulmonary sequestration in an adult: report of an operated case and review of the literature]. / Seqüestro pulmonar intra-abdominal em adulto: relato de um caso operado e revisão da literatura.

A 39-year-old man presenting fever and abdominal pain for three days was operated. He had similar but less severe complaint three weeks before. On admission, his temperature was around 38 degrees C and the abdomen was slightly tender in the left upper quadrant. His blood count showed 24,600 white cells/ml. Urinalysis, serum amylase and blood electrolytes were normal. Abdominal and chest roentgenograms were normal. An ultrasound examination showed an 8.7 x 6.2 cm cystic mass behind the spleen. At surgical intervention, a tumoral mass attached to the left hemidiaphragm, spleen and left adrenal gland was resected. The patient recovered uneventfully. The pathological examination showed pulmonary tissue and the diagnosis was that of an extrathoracic bronchopulmonary sequestration.

Pulmonary vein thrombosis after bilobectomy and development of collateral circulation.

Pulmonary vein thrombosis is a rare but potentially life threatening complication following lobectomy or bilobectomy. We present a case of right upper pulmonary vein thrombosis after a middle and lower lobectomy diagnosed at transoesophageal echocardiography. The patient was treated with antibiotics and anticoagulation with good recovery. Pulmonary angiography was performed 35 days after surgery and revealed the venous return of the right lung through the intercostal veins. Despite double venous drainage of the lungs consisting of bronchial and pulmonary veins, pulmonary to systemic collaterals following pulmonary vein thrombosis have not previously been reported. The development of this shunt can prevent gangrene, and surgical resection of the lung segment involved can be avoided.

A prognostic model of survival in surgically resected squamous cell carcinoma of the lung using clinical, pathologic, and biologic markers.

The biologic behavior of tumoral cells plays a significant role in the progression of the neoplasia, because 30 to 35% of patients with Stage I squamous cell carcinoma relapse. The present study was designed to determine whether age, pathologic parameters, DNA ploidy, and a cell proliferation index (the area of nucleolar organizer regions, AgNOR), could be used to predict survival in patients who undergo resection for limited squamous cell carcinoma of the lung. For histopathologic analysis, the parameters of histologic grading, pleural involvement, vascular invasion, and residual disease were considered. The cell proliferation index was evaluated by mitotic index, AgNOR quantification, and DNA ploidy by means of digital image analysis. Fifty-two patients (median age, 60 yr +/- 8.6 yr) were staged according to the TNM staging system. Cox univariate analysis showed that stage, residual disease, vascular invasion, histologic grading, DNA ploidy, and AgNOR were significant predictors of survival. Many of the univariate predictors of cancer death, however were eliminated when Cox multivariate models were computed. The variable that exhibited the most robust predictive value for overall survival was AgNOR. We conclude that measurement of cell proliferation might serve as a prognostic marker in squamous cell carcinoma of the lung.

Prognostic values of stromal proportion and PCNA, Ki-67, and p53 proteins in patients with resected adenocarcinoma of the lung.

Data from 64 patients who underwent surgical resection of lung adenocarcinomas were studied to identify clinicopathologic markers that might provide prognostic information on the clinical behavior of this neoplasia Patient staging was performed in accordance with the tumor-node-metastasis system as follows: Stage I (n = 29), Stage II (n = 11), Stage IIIA (n = 21), and Stage IIIB (n = 3). Overall follow-up time corresponded to the follow-up time for patients who were alive and to the survival time for patients who had died, all of them expressed in months. Data included age, staging, histologic type, morphometric assessment of histologic features related to tumor (stroma and vascularization), and immunohistochemical detection of proliferation cell markers (Ki-67 protein and proliferating cell nuclear antigen) and p53 protein. The morphometric assessment was made by the point-counting procedure. Data analysis included Life Tables for Survival and Cox Regression models. Overall follow-up analysis showed that significant univariate predictors (P < .05) were T stage; N stage; tumor stromal proportion; and immunohistochemical indexes of proliferating cell nuclear antigen, Ki-67, and p53 proteins. Variables that presented independent predictive value for overall follow-up with the multivariate model (P < .05) were sex, T stage, N stage, tumor stromal proportion, and immunohistochemical detection of p53 protein. We conclude that tumor stromal proportion and immunohistochemical detection of p53 protein, controlled for sex, T stage, and N stage, may be of critical value in the evaluation of recurrence of lung adenocarcinoma, serving as indicators for a more accurate prognosis.