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1.
Rev. cuba. cir ; 60(3): e1070, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347395

ABSTRACT

Introducción: El secuestro pulmonar está representado por masas de tejido pulmonar displásico, no funcionante, sin comunicación con el árbol bronquial. Objetivo: Presentar tres casos de secuestro pulmonar intralobar tratados por el autor. Caso clínico: Se presentan tres pacientes tratados entre 2013 y 2018 con diagnóstico de secuestro pulmonar. Dos fueron del sexo masculino (44 y 60 años de edad) y una del femenino (20 años de edad). Los síntomas fueron dolor torácico (1) y cuadro de infección pulmonar grave (2). En dos enfermos el secuestro se localizó en el lóbulo inferior derecho y en uno en el inferior izquierdo. Las operaciones fueron lobectomías inferiores derecha (1) e izquierda (1) y bilobectomía inferior y media derechas por afectación del lóbulo medio. Dos tuvieron una evolución satisfactoria y uno presentó un empiema pleural que resolvió con tratamiento antibiótico. Conclusiones: Los secuestros pulmonares son raros y los síntomas suelen asociarse con infección pulmonar. En la mayoría de los casos es necesario realizar una lobectomía. La evolución postoperatoria suele ser buena(AU)


Introduction: Pulmonary sequestration is characterized by masses of dysplastic, nonfunctioning lung tissue, without any communication with the bronchial tree. Objective: To present three cases of intralobar pulmonary sequestration treated by the author. Clinical case: The respective cases are presented of three patients with a diagnosis of pulmonary sequestration treated between 2013 and 2018. Two were male (44 and 60 years old, respectively) and one was female (20 years old). Their symptoms were chest pain (1) and severe lung infection (2). In two patients, the sequestration was located in the lower right lobe, while, in one, it was in the lower left lobe. The operations were right (1) and left (1) lower lobectomies and right lower and middle bilobectomy due to middle lobe involvement. Two had a satisfactory evolution, while one presented a pleural empyema healed with antibiotic treatment. Conclusions: Pulmonary sequestration is rare and their symptoms are usually associated with pulmonary infection. In most cases, a lobectomy is necessary. The postoperative evolution is usually good(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pneumonectomy/methods , Chest Pain/etiology , Thoracotomy/methods , Bronchopulmonary Sequestration/diagnosis , Anti-Bacterial Agents/therapeutic use
2.
Rev. cuba. cir ; 59(4): e1009, oct.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1149845

ABSTRACT

RESUMEN Introducción: La enfermedad pulmonar intersticial difusa constituye un grupo heterogéneo de lesiones con varias características comunes entre las cuales resaltan la inflamación y cicatrización del órgano. Por lo general, se requiere la obtención de tejido parenquimatoso para el diagnóstico definitivo. Objetivos: Describir los resultados obtenidos, según el método de minitoracotomía o cirugía torácica videoasistida, para obtener las muestras hísticas para estudio histopatológico. Métodos: Se realizó un estudio observacional, longitudinal y prospectivo de 52 pacientes consecutivos, con diagnóstico de enfermedad pulmonar intersticial difusa, a quienes se les practicó la toma de muestras tisulares obtenidas mediante cirugía torácica videoasistida o minitoracotomía en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" entre el 2001 y el 2018. Se estudió la edad y el sexo de los pacientes, la técnica quirúrgica empleada y las complicaciones y mortalidad. Los resultados se exponen en tablas, en números absolutos y relativos. Resultados: Predominó el sexo femenino (59,6 por ciento). La técnica quirúrgica más utilizada fue la minitoracotomía (75,0 por ciento) en pacientes entre 41-50 años, con 15 enfermos. La afección más frecuente fue la fibrosis pulmonar con un 78,8 por ciento. En dos enfermos intervenidos mediante cirugía torácica videoasistida no fue posible obtener tejido para biopsia (15,4 por ciento). Hubo dos complicaciones en pacientes operados mediante minitoracotomía. Conclusiones: La cirugía torácica videoasistida permite una amplia exploración de la superficie pulmonar, pero la biopsia abierta puede tener la misma efectividad para la obtención de muestras hísticas pulmonares, con un mínimo por ciento de complicaciones y bajo índice de mortalidad(AU)


ABSTRACT Introduction: Diffuse interstitial lung disease makes up a heterogeneous group of lesions with several common characteristics, among which inflammation and scarring of the organ stand out. Generally, obtaining parenchymal tissue is required for definitive diagnosis. Objectives: To describe the outcomes of using the method of minithoracotomy or video-assisted thoracic surgery to obtain tissue samples for histopathological study. Methods: An observational, longitudinal and prospective study was carried out with 52 consecutive patients with a diagnosis of diffuse interstitial lung disease. Tissue samples obtained by video-assisted thoracic surgery or mini-thoracotomy were taken at Hermanos Ameijeiras Clinical-Surgical Hospital, between 2001 and 2018. The age and sex of the patients, the surgical technique used, and complications and mortality were studied. The results are presented in tables, in absolute and relative numbers. Results: The female sex predominated (59.6 percent). The most widely used surgical technique was minithoracotomy (75.0 percent) in patients between 41-50 years (15 patients). The most frequent condition was pulmonary fibrosis, accounting for 78.8 percent. In two patients who underwent video-assisted thoracic surgery, it was not possible to obtain any tissue for biopsy (15.4 percent). There were two complications in patients operated on by minithoracotomy. Conclusions: Video-assisted thoracic surgery allows wide exploration of the lung surface, but open biopsy can be just as effective in obtaining lung tissue samples, with a minimum percentage of complications and a low mortality rate(AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Thoracotomy/methods , Lung Diseases, Interstitial/pathology , Thoracic Surgery, Video-Assisted/methods , Prospective Studies , Longitudinal Studies , Observational Studies as Topic
3.
Rev. bras. cir. cardiovasc ; 35(5): 831-833, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137329

ABSTRACT

Abstract Patent ductus arteriosus (PDA) is a clinical condition mostly found in premature newborns. Among several medical, surgical and interventional treatment options, extrapleural ligation through a left minithoracotomy is recognized as a safe, efficient and less expensive technique. In fact, it requires short surgical times, grants good exposure of the duct and nearby structures (e.g., thoracic duct, left recurrent laryngeal nerve), and avoids pleural space opening and subsequent pulmonary complications in preterm patients. This approach seems ideal due to its lower costs, especially in developing countries with a high birth rate and limited resources.


Subject(s)
Humans , Infant, Newborn , Thoracotomy/methods , Ductus Arteriosus, Patent/surgery , Ductus Arteriosus, Patent/diagnostic imaging , Pleura/surgery , Infant, Premature , Infant, Newborn, Diseases/surgery , Infant, Newborn, Diseases/diagnostic imaging , Ligation
4.
Rev. cuba. cir ; 59(3): e975, jul.-set. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144432

ABSTRACT

RESUMEN Introducción: Los teratomas se definen como tumores de tejidos extraños al órgano o sitio anatómico en el cual se originan. Los teratomas mediastinales no son frecuentes, representan alrededor del 5 por ciento al 10 por ciento de todos los tumores mediastinales. Objetivo: Describir los resultados del tratamiento quirúrgico de pacientes con diagnóstico de teratomas mediastinales. Métodos: Se estudiaron 12 pacientes tratados entre enero de 2001 y diciembre de 2018. Las variables evaluadas fueron sexo, edad, tipo histológico: maduro o inmaduro, vía de acceso quirúrgico, accidentes quirúrgicos y evolución postoperatoria. Resultados: Correspondieron 9 al sexo femenino y 3 al masculino. El promedio de edad fue de 33,3 años (17-60 años). Hubo predominio absoluto del tipo maduro (11). La esternotomía media fue el acceso más frecuente. La toracotomía se realizó cuando el tumor, voluminoso, ocupaba la mayor parte de un hemitórax. Los accidentes quirúrgicos fueron un desgarro pulmonar y una apertura del pericardio. De dos pacientes tratados mediante cirugía torácica videoasistida, uno fue convertido por sangrado venoso molesto. Al año de seguimiento todos estaban vivos, sin evidencias de recidiva. Conclusiones: Contrariamente a lo esperado, hay predominio del sexo femenino, mientras que la edad y el tipo histológico coinciden con la literatura. La esternotomía, aún hoy, es comúnmente aceptada, a pesar del auge de la cirugía torácica videoasistida. La resección total produce resultados excelentes para los teratomas benignos(AU)


ABSTRACT Introduction: Teratomas are defined as tumors of tissues foreign to the organ or anatomical site in which they originate. Mediastinal teratomas are rare, accounting for about 5-10 percent of all mediastinal tumors. Objective: To describe the outcomes of the surgical treatment of patients diagnosed with mediastinal teratomas. Methods: Twelve patients treated between January 2001 and December 2018 were studied. The variables evaluated were sex, age, histological type (mature or immature), surgical access route, surgical accidents, and postoperative evolution. Results: Nine patients corresponded to the female sex and three, to the male. The average age was 33.3 years (17-60 years). There was an absolute predominance of the mature type (11). Median sternotomy was the most frequent access. Thoracotomy was performed when the bulky tumor occupied most of a hemithorax. The surgical accidents were lung tear and opening of the pericardium. Of two patients treated by video-assisted thoracic surgery, one was converted for bothersome venous bleeding. At one year of follow-up, all were alive, with no evidence of recurrence. Conclusions: Contrary to expectations, there is predominance of the female sex, while age and histological type coincide with the literature. Sternotomy, even today, is commonly accepted, despite the rise of video-assisted thoracic surgery. Total resection produces excellent outcomes in benign teratomas(AU)


Subject(s)
Humans , Male , Female , Adult , Teratoma/diagnosis , Thoracotomy/methods , Thoracic Surgery, Video-Assisted/methods , Sternotomy/methods , Retrospective Studies
5.
Rev. Col. Bras. Cir ; 47: e20202435, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136608

ABSTRACT

ABSTRACT Objective: Since its first report, video-assisted thoracic surgery (VATS) lung lobectomy was carried out with the use of conventional surgical instruments, used in laparoscopy and open thoracotomy. These instruments are expensive, not standardized and there are a variety of models and manufacturers. The aim of this study was to determine the impact of the use of these instruments on the experimental pulmonary lobectomy. Methods: We used a modified surgical simulator that uses a porcine heart-lung block filled with tomato sauce, and tested specific (Group 1) and regular (Group 2) instruments. Each group includes 15 experiments. Results: The median total time, excluding the time spent to correct the lesions, was 45.08 and 45.81 minutes, respectively in Group 1 and Group 2. There was no statistical difference between the total times (p=0.58). The only statistically different was seen for partial times regarding the elapsed time to cut and suture of lung fissures (p=0.03 and 0.04, respectively). There were more direct lesions and indirect leaks in Group 2, but without statistical significance (p=1.000 and p=0.203, respectively). The mean time spent for the diagnosis and correction of these events was 1.77 minutes with a standard deviation of 1.18 for Group 1 and 2.72 ± 1.11 minutes for Group 2 (p=0.044). Conclusion: The use of minimally invasive instruments is not associated with time improvement spent with experimental video-assisted lung lobectomy and does not lead to a faster or safer surgery. The use of VATS instruments makes correction of adverse events faster when they occur.


RESUMO Objetivo: desde os primeiros registros, a lobectomia pulmonar por cirurgia torácica videoassistida (CTVA) foi feita usando instrumentos convencionais e de laparoscopia. Recentemente instrumentais específicos para CTVA surgiram. Esses instrumentais têm custo elevado, não são padronizados existindo uma variedade de modelos e fabricantes. Buscou-se determinar o impacto do uso desses instrumentais na realização da lobectomia pulmonar superior esquerda experimental. Métodos: foi usado simulador modificado com bloco de coração-pulmões preenchidos com molho de tomate para testar o uso de instrumental dedicado de CTVA e de cirurgia convencional (Grupo 1 e Grupo 2, respectivamente). Cada grupo inclui 15 experimentos. Resultados: a mediana do tempo total, excluído o tempo para corrigir vazamentos, foi de 45,8 e 45,81 minutos, respectivamente para o Grupo 1 e Grupo 2. Não houve diferença estatisticamente significante entre os tempos totais (p=0,58). Os únicos tempos parciais estatisticamente diferentes foram os para cortar e suturar a fissura pulmonar (p=0,03 e 0,04, respectivamente). Ocorreram mais lesões diretas e vazamentos indiretos no Grupo 2, mas sem significância estatística (p=1,000 e 0,203, respectivamente). A média de tempo gasto para diagnosticar e corrigir os eventos de lesão e vazamento foi de 1,77 minutos com desvio padrão de 1,18 para o Grupo 1 e 2,72±1,11 minutos para o Grupo 2 (p=0,044). Conclusão: o uso de instrumentos para CTVA não torna a cirurgia mais rápida, nem mais segura. O uso de instrumentos de CTVA permitiu uma correção mais rápida dos eventos adversos ocorridos.


Subject(s)
Humans , Pneumonectomy/instrumentation , Surgical Instruments , Thoracotomy/instrumentation , Thoracic Surgery, Video-Assisted/instrumentation , Pneumonectomy/methods , Thoracotomy/methods , Thoracic Surgery, Video-Assisted/methods , Simulation Training/methods
6.
Einstein (Säo Paulo) ; 18: eAO4409, 2020. tab, graf
Article in English | LILACS | ID: biblio-1039728

ABSTRACT

ABSTRACT 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.


RESUMO Objetivo Comparar a drenagem torácica pela mesma intercostotomia à drenagem tradicional em pacientes submetidos à toracotomia poupadora lateral. Métodos Foram avaliados 40 pacientes maiores de 18 anos submetidos a toracotomias poupadoras laterais eletivas. Eles foram separados em dois grupos de 20 pacientes cada, sendo um submetido à drenagem torácica pelo mesmo espaço intercostal da toracotomia e o outro à drenagem tradicional. Resultados No grupo da drenagem pela mesma intercostotomia, a mediana de tempo de internação em unidade de terapia intensiva foi de 1,5 dia (1,0 a 2,0 dias) e de 2,0 dias (1,25 a 3,0 dias) na drenagem tradicional (p=0,060). As medianas do tempo de internação (p=0,527) e de drenagem (p=0,547) foram ambas de 4 dias, no primeiro grupo, e de 2 e 5,5 dias, no grupo com drenagem tradicional. As doses utilizadas de dipirona e de tramadol não apresentaram diferenças estatísticas entre os grupos (p=0,201 e p=0,341). As médias da escala de dor foram 4,24 no primeiro dia pós-operatório do grupo com a drenagem proposta e 3,95 nos drenados da forma tradicional (p=0,733); no terceiro pós-operatório, foi de 3,18 para o grupo drenado pela incisão e de 3,11 nos drenados da forma tradicional (p=0,937). No 15º dia após a cirurgia, a drenagem pela incisão foi de 1,53 e a tradicional de 2,11 (p=0,440); no 30º pós-operatório, foi de 0,71 e 0,84, respectivamente, para a incisão e a forma tradicional (p=0,787). Em relação às complicações, os grupos foram semelhantes, com 30% na drenagem proposta e 25% na drenagem tradicional (p=0,723). Conclusão A drenagem pelo mesmo espaço intercostal foi exequível e não apresentou inferioridade à técnica tradicional no período pós-operatório estudado de 30 dias.


Subject(s)
Humans , Thoracotomy/methods , Chest Tubes , Drainage/methods , Pain, Postoperative/drug therapy , Postoperative Period , Atrial Fibrillation/etiology , Tramadol/therapeutic use , Pain Measurement , Thoracotomy/adverse effects , Analgesia, Epidural , Drainage/statistics & numerical data , Dipyrone/therapeutic use , Prospective Studies , Dyspnea/etiology , Analgesics/therapeutic use , Length of Stay
7.
Rev. bras. anestesiol ; 69(4): 417-419, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1042012

ABSTRACT

Abstract Erector spinae plane block is gaining popularity both for its ease of application and as its comparable effect on postoperative analgesia with central regional techniques like paravertebral block or epidural anesthesia. Its use for many indications has been reported in the literature for pediatric patients. We would like to share our experiences in a 2.5-month infant scheduled for thoracotomy for a giant congenital cyst. Single shot erector spinae plane block was done at T4 level before the start of the surgery for both surgical and postoperative analgesia. No complication was seen during both surgery and follow up period. Erector spinae plane block with the combination of paracetamol was adequate for pain relief.


Resumo O bloqueio do plano do músculo eretor da espinha tem ganhado popularidade, tanto pela facilidade de aplicação quanto pelo efeito comparável em analgesia pós-operatória com técnicas regionais centrais, como o bloqueio paravertebral ou a anestesia peridural. Seu uso tem sido relatado na literatura para muitas indicações em pacientes pediátricos. Gostaríamos de compartilhar nossas experiências no caso de um bebê de 2,5 meses de idade programado para toracotomia para excisão de um cisto congênito gigante. O bloqueio do plano do eretor da espinha dorsal com injeção única foi realizado no nível de T4 antes do início da cirurgia para analgesia cirúrgica e pós-operatória. Nenhuma complicação foi observada durante a cirurgia e o período de acompanhamento. O bloqueio do plano do eretor da espinha com a combinação de paracetamol foi adequado para o alívio da dor.


Subject(s)
Humans , Infant, Newborn , Pain, Postoperative/prevention & control , Thoracotomy/methods , Nerve Block/methods , Follow-Up Studies , Analgesics, Non-Narcotic/administration & dosage , Cysts/surgery , Cysts/congenital , Acetaminophen/administration & dosage
8.
Rev. bras. cir. cardiovasc ; 34(4): 428-435, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1020490

ABSTRACT

Abstract Objective: To analyze and summarize the clinical safety and feasibility of minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision in patients aged over 65 years. Methods: The clinical data of 45 patients over 65 years old who had mitral valve disease were analyzed retrospectively from January 2014 to January 2017 at Union Hospital, Fujian Medical University. The patients were divided into two groups; 20 patients in group A, who underwent minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision, and 25 patients in group B, who underwent conventional mitral valve replacement. We collected and analyzed their relevant clinical data. Results: The operation was completed successfully in both groups. Compared with group B, group A was clearly superior for postoperative analgesia time, postoperative hospital length of stay, thoracic drainage liquid, blood transfusion, and length of incision. There were no differences between the two groups in postoperative severe complications and mortality. More patients in group B had pulmonary infections and poor incision healing, while more patients in group A had postoperative pneumothorax and subcutaneous emphysema. Conclusion: In patients aged over 65 years, minimally invasive video-assisted mitral valve replacement with a small incision in the right chest had the same clinical safety and efficacy as the conventional method.


Subject(s)
Humans , Male , Female , Aged , Minimally Invasive Surgical Procedures/methods , Heart Valve Prosthesis Implantation/methods , Video-Assisted Surgery/methods , Heart Valve Diseases/surgery , Mitral Valve/surgery , Postoperative Complications , Thoracotomy/methods , Echocardiography/methods , Retrospective Studies , Surgical Wound
9.
Rev. bras. anestesiol ; 69(2): 144-151, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003406

ABSTRACT

Abstract Background and objective: Thoracic paravertebral blockade is an alternative regional technique for comforting post-thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography-guided paravertebral blockade. Material and method: 93 ASA I-II patients aged 18-65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20 mL 0.5% bupivacaine injection in Group B (n = 31) and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 µg) injection in Group BD. Group C received postoperative i.v. morphine via patient-controlled analgesia without paravertebral blockade. Post-operative pain scores were recorded in the recovery room and post-operatively using a VAS. Hemodynamic parameters, adverse effects and morphine consumption were also recorded. Results: No significant difference was determined between Group B and Group C regarding intra-operative adverse effects such as bradicardia and hypotension, while these adverse effects were significantly higher in Group BD (p = 0.04). VAS scores with rest and upon movement were significantly lower in Group BD compared to Group C (p < 0.001). Total morphine consumption was significantly lower in both Group B and Group BD in comparison with Group C (p < 0.001). In Group BD, HR and MAP were lower, but this was not clinically significant (p < 0.05). Conclusion: The addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade.


Resumo Justificativa e objetivo: O bloqueio paravertebral torácico é uma técnica regional opcional para o alívio da dor pós-toracotomia, deste modo diminui o consumo de opioides, náuseas e vômitos no pós-operatório, tontura, depressão respiratória e custos com saúde. O objetivo deste estudo foi investigar os efeitos de bupivacaína isolada e bupivacaína + dexmedetomidina no escore de dor pós-operatória e no consumo de analgésicos em pacientes submetidos à toracotomia sob bloqueio paravertebral guiado por ultrassom. Material e método: Noventa e três pacientes, ASA I-II, com idades entre 18 e 65 anos, foram incluídos no estudo e programados para cirurgia torácica. Antes da indução anestésica, o procedimento de bloqueio paravertebral foi realizado por um anestesista com o uso de ultrassom. Os casos foram estratificados aleatoriamente em três grupos. O procedimento de bloqueio paravertebral foi realizado com injeção de 20 mL de bupivacaína a 0,5% no Grupo B (n = 31) e de 20 mL de bupivacaína a 0,5% + 1 mL de dexmedetomidina (100 µg) no Grupo BD. O Grupo C recebeu morfina intravenosa via analgesia controlada pelo paciente sem bloqueio paravertebral. Os escores de dor pós-operatória foram registrados na sala de recuperação e no pós-operatório usando a escala VAS. Parâmetros hemodinâmicos, efeitos adversos e consumo de morfina também foram registrados. Resultados: Não houve diferença significativa entre os grupos B e C em relação a efeitos adversos intraoperatórios, como bradicardia e hipotensão, enquanto esses efeitos adversos foram significativamente maiores no Grupo BD (p = 0,04). Os escores VAS em repouso e movimento foram significativamente menores no Grupo BD em relação ao Grupo C (p < 0,001). O consumo total de morfina foi significativamente menor nos grupos B e BD em comparação com o Grupo C (p < 0,001). No Grupo BD, a frequência cardíaca e a pressão arterial média foram menores, mas esse resultado não foi clinicamente significativo (p < 0,05). Conclusão: A adição de dexmedetomidina à bupivacaína reduz os escores de dor pós-operatória e o consumo de morfina em pacientes submetidos à toracotomia sob bloqueio paravertebral guiado por ultrassom.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Pain, Postoperative/prevention & control , Bupivacaine/administration & dosage , Dexmedetomidine/administration & dosage , Nerve Block/methods , Thoracotomy/methods , Double-Blind Method , Prospective Studies , Analgesia, Patient-Controlled/methods , Ultrasonography, Interventional/methods , Analgesics, Non-Narcotic/administration & dosage , Drug Synergism , Drug Therapy, Combination , Analgesics, Opioid/administration & dosage , Anesthetics, Local/administration & dosage , Middle Aged , Morphine/administration & dosage
10.
Rev. chil. cir ; 71(1): 66-69, feb. 2019. ilus
Article in Spanish | LILACS | ID: biblio-985381

ABSTRACT

Resumen Introducción: El doble arco aórtico (DAA) es una malformación cardiovascular infrecuente caracterizada por la persistencia de ambos arcos aórticos posterior al nacimiento. Puede presentarse con rama derecha dominante (70-73%), izquierda o simétrica. Su forma anatómica produce compresión de estructuras mediastínicas como la tráquea y esófago. Caso clínico: Lactante menor hombre de 3 meses, con antecedente de estridor desde nacimiento. Ingresó a nuestro centro por neumonía grave con necesidad de ventilación mecánica prolongada. Evaluado por otorrinolaringología, se realizó revisión de vía aérea, observando estenosis en los últimos 5 anillos traqueales con colapso dinámico de la tráquea. La tomografía computada de tórax demostró DAA completo con emergencias de troncos supraaórticos de ambos arcos de forma simétrica. Se decidió tratamiento quirúrgico a la brevedad. Se abordó por toracotomía anterolateral izquierda, se realizó control vascular y sección del arco aórtico izquierdo distal a emergencia de subclavia, con plastía de aorta y arteria subclavia izquierda, liberado el arco aórtico se realizó pexia y disección de tejido fibrótico que rodeaba tráquea y esófago. Paciente evolucionó favorablemente, con resolución de cuadro respiratorio y ausencia estridor. Fibrobroncoscopía posoperatoria no observó compresión traqueal. El alta hospitalaria fue al 14° día posoperatorio. Actualmente, a seis meses de seguimiento, se encuentra asintomático respiratorio y cardiovascular. Discusión: El DAA puede afectar al 0,03% de la población pediátrica. Usualmente es sintomático con manifestaciones obstructivas como estridor o disfagia por compresión de estructuras mediastínicas, por lo que requiere alta sospecha clínica para su confirmación imagenológica y posterior tratamiento quirúrgico.


Introduction: The double aortic arch (DAA) is an uncommon cardiovascular malformation, characterized by the persistence of both aortic arches after birth. It can be presented with right dominant branch (70-73%), left or symmetrical. It's anatomical shape produces compression of mediastinal structures such as the trachea and esophagus. Clinic case: Infant man 3 months old, with a history of stridor since birth. He was admitted to our center due to severe pneumonia with the need for prolonged mechanical ventilation. Evaluated by otorhinolaryngology, who performed airway revision observing stenosis in the last 5 tracheal rings with dynamic trachea collapse. Chest computed tomography showed complete DAA with emergence of supraaortic trunks of both arches symmetrically. Surgical treatment was decided as soon as possible. It was approached by left anterolateral thoracotomy, vascular control and left aortic arch section distal to subclavian emergency was performed, with aortic and left subclavian artery plasty, aortic arch was released to perform pexia and dissection of fibrotic tissue surrounding the trachea and esophagus. Patient evolved favorably, with resolution of respiratory symptoms and absence of stridor. Postoperative fiberoptic bronchoscopy did not observe tracheal compression. He was discharged on the 14th postoperative day. Currently at six months of follow-up, he is asymptomatic respiratory and cardiovascular. Discussion: AAD can affect 0.03% of the pediatric population. It is usually symptomatic with obstructive manifestations such as stridor or dysphagia due to compression of mediastinal structures, which requires high clinical suspicion for its imaging confirmation and subsequent surgical treatment.


Subject(s)
Humans , Male , Infant , Thoracotomy/methods , Vascular Ring/surgery , Vascular Ring/diagnostic imaging , Postoperative Period , Tomography, X-Ray Computed , Treatment Outcome , Cardiovascular Abnormalities
11.
Article in Spanish | LILACS, BINACIS | ID: biblio-1003010

ABSTRACT

Existen múltiples técnicas para la descompresión medular en la columna torácica, cada una con sus ventajas y desventajas, y con distintos requerimientos de destrezas quirúrgicas. Se han desarrollado técnicas mínimamente invasivas que disminuyen las tasas de morbilidad, con buenos resultados funcionales. Se presenta el caso de un hombre de 64 años, con clínica de compresión medular, una hernia de disco central, calcificada a nivel del quinto disco torácico, migrada hasta el borde inferior de la sexta vértebra torácica, con franca compresión medular. Se realizó un abordaje lateral transpleural mínimamente invasivo, con una corpectomía parcial posterior de la sexta vértebra, sin fijación adicional. El paciente tuvo una buena evolución, sin progresión del cuadro neurológico ni dolor costal residual. Los abordajes laterales mínimamente invasivos son técnicas válidas para tratar patologías compresivas de la columna torácica, con bajas tasas de morbimortalidad y una rápida recuperación. Nivel de Evidencia: IV


There are multiple techniques for spinal cord decompression in the thoracic spine, each with its advantages and disadvantages and requiring surgical skills. Recently, minimally invasive techniques have been developed reducing morbidity rates, achieving good functional results. We present the case of a 64-year-old male patient with a spinal compression symptoms, central disc herniation, calcified at the fifth thoracic vertebra which migrated to the lower end of the sixth thoracic vertebra, Diagnosis was clear for spinal cord compression. Partial posterior corpectomy of the sixth vertebra was performed with a minimally invasive transthoracictranspleural lateral approach and without additional fixation. The patient had a good outcome on follow-up, without progression of neurological symptoms or residual rib pain. Minimally invasive lateral approaches are valid techniques for the treatment of compression disorders of the thoracic spine, with low rates of morbidity and mortality, and a rapid recovery. Level of Evidence: IV


Subject(s)
Middle Aged , Scoliosis/surgery , Thoracic Vertebrae/surgery , Thoracotomy/methods , Minimally Invasive Surgical Procedures , Decompression, Surgical
12.
Rev. argent. cir ; 110(2): 109-110, jun. 2018. ilus
Article in Spanish | LILACS | ID: biblio-957904

ABSTRACT

La incidencia de roturas traqueobronquiales secundarias a un traumatismo torácico cerrado es baja, y la mayoría de estos pacientes no llegan con vida a los centros de atención hospitalaria. La presentación clínica es variable dependiendo de la localización de las lesiones, los daños asociados y si las estructuras peribronquiales permanecen íntegras. Para su diagnóstico temprano se debe tener un alto índice de sospecha clínica y una correcta interpretación de los hallazgos semiológicos y radiológicos, lo que permite su rápida y correcta resolución. La demora en el tratamiento aumenta tanto la mortalidad como las complicaciones tempranas y tardías.


The incidence of tracheobronchial ruptures secondary to blunt thoracic trauma is low and most affected patients do not arrive alive to hospitals. Clinical presentation varies with the location of lesions, associated injuries and whether the peribronchial structures remain intact. Early diagnosis requires a high index of clinical suspicion and a correct interpretation of semiologic and radiologic findings, which allows for a rapid and correct resolution. Delay in treatment increases the mortality as well as early and late complications.


Subject(s)
Humans , Female , Adolescent , Thoracic Injuries/complications , Bronchi/injuries , Fractures, Avulsion/diagnostic imaging , Subcutaneous Emphysema/diagnostic imaging , Thoracotomy/methods , Radiography, Thoracic , Tomography, X-Ray Computed , Lung/diagnostic imaging , Mediastinal Emphysema
14.
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 31(1): 17-19, jan.-mar. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-905677

ABSTRACT

A cirurgia minimamente invasiva é segura e eficaz no tratamento de diversas afecções cardíacas, com evolução intra-hospitalar bastante positiva. Descrevemos aqui o caso de paciente do sexo masculino, com 72 anos de idade, portador de comunicação interatrial com shunt bidirecional e bloqueio atrioventricular avançado com síncope. Foi contraindicado o fechamento da comunicação interatrial e indicado marcapasso dupla-câmara com cabos-eletrodos epicárdicos em decorrência da presença do shunt. O procedimento foi realizado por meio de minitoracotomia direita, com implante de cabos-eletrodos atrial e ventricular direitos bipolares, com gerador implantado em loja subcutânea na região infraclavicular direita. O paciente apresentou boa evolução, recebendo alta no quarto dia de pós-operatório em boas condições


Minimally invasive cardiac surgery is safe and effective in the treatment of a wide range of cardiac diseases, with very positive in-hospital outcomes. We describe the case of a 72-year-old male patient, with atrial septal defect, bidirectional shunt and advanced atrioventricular block with syncope. The atrial septal defect closure was contraindicated and he was referred for a dual-chamber pacemaker and epicardial leads implantation due to the presence of shunt. The patient underwent a right minithoracotomy with the implantation of bipolar atrial and ventricular leads and placement of a pacemaker generator in a subcutaneous envelope in the right infraclavicular region. The patient evolved well and was discharged on the fourth postoperative day in good conditions


Subject(s)
Humans , Male , Aged, 80 and over , Pacemaker, Artificial , Pericardium , Thoracotomy/methods , Electrodes , Heart Atria , Heart Block/therapy , Heart Septal Defects, Atrial/therapy , Thoracic Surgery/methods
15.
Acta cir. bras ; 33(1): 49-66, Jan. 2018. tab, graf
Article in English | LILACS | ID: biblio-886249

ABSTRACT

Abstract Purpose: To evaluate the most used approach to treat traumatic diaphragmatic ruptures, and in which one the requirement to assess the second cavity is more frequent. Methods: Systematic review, observational studies. Outcomes: moment of approach, most commonly via addressed and the requirement to open the other cavity. Bases searched: Lilacs, Pubmed, Embase, Clinicaltrials.gov and Web of Science. Statistical analysis: StatsDirect 3.0.121 software. Results: Sixty eight studies (2023 participants) were included. Approach in acute phase was performed four times more than in chronic phase. Approach: abdominal 65% (IC 95% 63-67%), thoracic 23% (IC 95% 21-24%), abdominal in the acute phase 75% (IC 95% 71-78%), and chronic 24% (IC 95% 19-29%), thoracic in the acute phase 12% (IC 95% 10-14%) and chronic 69% (IC 95% 63-74%). Thorax opening in the abdominal approach: 10% (95% CI 8-14%). Abdomen opening in the thoracic approach: 15% (95% CI 7-24%). Conclusions: The most common approach was the abdominal. The approach in the acute phase was more common. In the acute phase the abdominal approach is more frequent than the thoracic approach. In the chronic phase the thoracic approach is more frequent than the abdominal one. The requirement to open the second cavity was similar in both approaches.


Subject(s)
Humans , Thoracotomy/methods , Hernia, Diaphragmatic, Traumatic/surgery , Laparotomy/methods , Wounds, Nonpenetrating/surgery , Acute Disease , Chronic Disease , Reproducibility of Results
16.
ABCD arq. bras. cir. dig ; 31(2): e1365, 2018. tab
Article in English | LILACS | ID: biblio-949218

ABSTRACT

ABSTRACT Background : The muscle-sparing thoracotomy (MST) has not yet been thoroughly studied and assessed in comparison to the traditional thoracotomy method in newborns. Aim : To compare the outcomes of MST and standard posterolateral thoracotomy (PLT) in newborns. Methods : Randomized, controlled, double-blind trial on 40 neonates with esophageal atresia, comparing the time of beginning a surgery until seeing the pleura, the duration of hospitalization in the neonatal intensive care unit, the time in ventilator, the time of returning the shoulder function, the time of returning the Moro reflex, and the mortality between the two techniques. Results : The data showed no differences between the two groups in basic information (weight, height, gender, numbers of prematurity neonates and caesarean). The results on the size of the scar in the MST group was significantly lower than in the PLT group. Also, the time of returning the shoulder function in MST group was earlier than in PLT group. There were no significant differences in the duration since the beginning the surgery to see the pleura, the time of being hospitalized in intensive unit, the time that the infant required ventilator, returning time of the Moro reflex in 1st and 3rd months after the operation, and the mortality rates between MST and PLT groups. Conclusion : It seems that the advantages of using MST over PLT procedure in neonates include the earlier shoulder function recovery and also superior cosmetic results.


RESUMO Racional : A técnica de toracotomia poupadora de músculo (MST) ainda não foi estudada e avaliada em relação ao método tradicional de toracotomia em recém-nascidos. Objetivo : Comparar os resultados da MST e toracotomia posterolateral padrão (PLT) em recém-nascidos. Métodos : Ensaio randomizado, controlado, duplamente cego em 40 neonatos com atresia esofágica, comparando o tempo de início da incisão até ver a pleura, a duração da hospitalização na unidade de terapia intensiva neonatal, o tempo em ventilador, o tempo da volta da função do ombro, tempo de retorno do reflexo Moro e mortalidade entre as duas técnicas. Resultados : Os dados não mostraram diferenças entre os dois grupos em informações básicas (peso, altura, gênero, número de neonatos de prematuridade e cesariana). Os resultados sobre o tamanho da cicatriz no grupo MST foram significativamente menores do que no grupo PLT. Além disso, o tempo de retorno da função do ombro no grupo MST foi mais precoce do que no grupo PLT. Não houve diferenças significativas na duração desde o início da operação até a pleura ser vista, o tempo de hospitalização em unidade intensiva, o tempo que a criança necessitou de ventilador, retorno do reflexo Moro nos 1º e 3º meses após a operação, e as taxas de mortalidade entre os grupos. Conclusão : As vantagens de usar o procedimento MST sobre PLT em neonatos incluem a recuperação da função do ombro e também resultados cosméticos superiores.


Subject(s)
Humans , Male , Female , Infant, Newborn , Thoracotomy/methods , Esophageal Atresia/surgery , Organ Sparing Treatments , Pectoralis Muscles , Double-Blind Method , Superficial Back Muscles
17.
Rev. bras. cir. cardiovasc ; 32(4): 270-275, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-897925

ABSTRACT

Abstract Objective: Midline sternotomy is the preferred approach for device migration following transcatheter device closure of ostium secundum atrial septal defect. Results of patients operated for device migration were retrospectively reviewed after transcatheter closure of atrial septal defect. Methods: Among the 643 patients who underwent atrial septal defect with closure device, 15 (2.3%) patients were referred for device retrieval and surgical closure of atrial septal defect. Twelve patients underwent device retrieval and surgical closure of atrial septal defect through right antero-lateral minithoracotomy with femoral cannulation. Three patients were operated through midline sternotomy. Results: Twelve patients operated through minithoracotomy did not require conversion to sternotomy. Due to device migration to site of difficult access through thoracotomy, cardiac tamponade and hemodynamic instability, respectively, three patients were operated through midline sternotomy. Mean aortic cross-clamp time and cardiopulmonary bypass time were 28.1±17.7 and 58.3±20.4 minutes, respectively. No patient had surgical complication or mortality. Mean intensive care unit and hospital stay were 1.6±0.5 days and 7.1±2.2 days, respectively. Postoperative echocardiography confirmed absence of any residual defect and ventricular dysfunction. In a mean follow-up period of six months, no mortality was observed. All patients were in New York Heart Association class I without wound or vascular complication. Conclusion: Minithoracotomy with femoral cannulation for cardiopulmonary bypass is a safe-approach for selected group of patients with device migration following transcatheter device closure of atrial septal defect without increasing the risk of cardiac, vascular or neurological complications and with good cosmetic and surgical results.


Subject(s)
Humans , Male , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Thoracotomy/methods , Foreign-Body Migration/surgery , Septal Occluder Device/adverse effects , Heart Septal Defects, Atrial/surgery , Catheterization/methods , Cardiopulmonary Bypass/methods , Retrospective Studies , Foreign-Body Migration/complications , Treatment Outcome , Femoral Artery , Sternotomy/methods , Heart Septal Defects, Atrial/diagnostic imaging
18.
Rev. bras. cir. cardiovasc ; 32(2): 111-117, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-843472

ABSTRACT

Abstract INTRODUCTION: The biggest challenge faced in minimally invasive pediatric cardiac surgery is cannulation for cardiopulmonary bypass. Our technique and experience of cervical cannulation in infants and small children for repair of congenital cardiac defects is reported in this study. METHODS: From January 2013 to June 2015, 37 children (22 males) with mean age of 17.97±8.63 months and weight of 8.06±1.59 kg were operated on for congenital cardiac defects through right lateral thoracotomy. The most common diagnosis was ventricular septal defect (18 patients). In all patients, right common carotid artery, right internal jugular vein and inferior vena cava were cannulated for institution of cardiopulmonary bypass and aorta was cross clamped through right 2nd intercostal space. RESULTS: There were no deaths or any major complications related to cervical cannulation. Common carotid artery cannulation provided adequate arterial inflow while internal jugular vein with inferior vena cava provided adequate venous return in all patients. No patient required conversion to sternotomy or developed vascular, neurological or wound related complications. Three patients had residual lesions (small leak across ventricular septal defect patch-2, Grade II left atrio-ventricular valve regurgitation-1) and one patient had mild left ventricular dysfunction. At discharge, both common carotid artery and internal jugular vein were patent on color Doppler ultrasonography in all patients. In a mean follow-up period of 11.4±2.85 months, all patients were doing well. No patient had any wound related, neurological or vascular complication. No patient had residual leak across ventricular septal defect patch. CONCLUSION: Cervical cannulation of common carotid artery and internal jugular vein is a safe, reliable, efficient and quick method for institution of cardiopulmonary bypass in minimally invasive pediatric cardiac surgery.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Vena Cava, Inferior , Catheterization/methods , Carotid Artery, Common , Heart Defects, Congenital/surgery , Jugular Veins , Postoperative Period , Thoracotomy/methods , Catheterization/instrumentation , Echocardiography , Cardiopulmonary Bypass/methods , Retrospective Studies , Heart Defects, Congenital/diagnostic imaging , Heart Septal Defects, Ventricular/surgery , Heart Septal Defects, Ventricular/diagnostic imaging
19.
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 30(1): f:28-l:30, jan.-mar. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-837262

ABSTRACT

Relatamos o caso de paciente portador de cardiomiopatia hipertrófica, submetido a implante de cardioversor-desfibrilador implantável, que evoluiu, na primeira semana de pós-operatório, com dor torácica, síncope e choque cardiogênico. À ecocardiografia transtorácica, diagnosticou-se derrame pericárdico e perfuração do ventrículo direito pelo cabo-eletrodo de choque. Foi submetido a toracotomia de urgência e rafia do miocárdio com resolução do quadro. As possíveis razões desse desfecho são discutidas, comparativamente a outros casos na literatura


We report the case of a patient with hypertrophic cardiomyopathy, submitted to an implantable cardioverter defibrillator implant who developed chest pain, syncope, and cardiogenic shock in the first post-operative week. Pericardial effusion and right ventricular perforation by shock lead were diagnosed by transthoracic echocardiography. The patient underwent emergency thoracotomy and myocardial raffia with resolution of the condition. We discuss the possible reasons for this outcome and compare it to other cases in the literature


Subject(s)
Humans , Male , Middle Aged , Defibrillators, Implantable/adverse effects , Electrodes , Heart Ventricles , Cardiac Tamponade/complications , Cardiac Tamponade/diagnosis , Heart , Radiography/methods , Thoracotomy/methods
20.
Clinics ; 71(4): 232-234, Apr. 2016. graf
Article in English | LILACS | ID: lil-781420

ABSTRACT

Cardiopulmonary bypass causes an inflammatory response and consumption of coagulation factors, increasing the risk of bleeding and neurological and renal complications. Its use during lung transplantation may be due to pulmonary hypertension or associated cardiac defects or just for better exposure of the pulmonary hilum. We describe a simple technique, or open pericardium retraction, to improve hilar exposure by lifting the heart by upward retraction of the pericardial sac. This technique permits lung transplantation without cardiopulmonary bypass when bypass use is recommended only for better exposure.


Subject(s)
Humans , Cardiopulmonary Bypass , Lung Transplantation/methods , Pericardium , Thoracotomy/methods , Hemodynamics , Lung Transplantation/instrumentation , Medical Illustration
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