[A retrospective study on the quality of life of patients with primary focal hyperhidrosis that underwent a video-assisted thoracoscopic sympathectomy]. / Avaliação do Impacto na Qualidade de Vida de Pacientes Diagnosticados com Hiperdrose Primária Submetidos a Simpaticectomia Torácica por Vídeo-Toracoscopia.

Backgroud: Primary focal hyperhidrosis affects between 1 to 4% of the general population, with a higher prevalence in teenagers and young adults. The condition is characterized by excessive sweating in 1 or more body part, most often the palms, face, armpits and soles. This condition causes a significant negative impact on patient's quality of life. The pathophysiology of focal hyperhidrosis is believed to be due to excessive sympathetic stimulation, and videothoracoscopic sympathectomy is a recognized form of treatment. The aim of this study is to evaluate the post-operative quality of life of patients who underwent thoracoscopic sympathectomy. MATERIALS AND METHODS: This is a retrospective study of fifty-four patients with primary focal hyperhidrosis submitted to bilateral thoracoscopic thoracic sympathectomy at the Center of Cardiothoracic Surgery of Casa de Saúde da Boavista, between January 2011 and December 2014. The Quality of Life questionnaire and the Hyperhidrosis Severity Scale questionnaire were used to evaluate the quality of life in the pre-operative period and 3 months after surgery. Further to this, data was collected regarding medium-term follow-up by telephone. All patients underwent general anesthesia and had bilateral video-assisted thoracoscopic resection of the sympathetic chain. RESULTS: The majority of patients are females 59.3% (32). The mean age is 30.8 ± 7.70 (between 16 and 49 years). Prior to surgery, 85% of the patients had severe hyperhidrosis. 79.6% of respondents stated that general discomfort was promoted by the condition, with the Funcional-Social domain being the most affected aspect of their life (61.1%). The rates of peri-operative complications and major post-operative complications were null, and minor complications were 5.5%. After 3 months, improvement in patient's quality of life and satisfaction level were of 100% and 96.3% respectively, however compensatory hyperhidrosis was observed in 53.7% of patients. 57.3% of the patients reported significant improvements in the Funcional-Social domain. Medium-term follow-up (mean=6 years) allowed for the evaluation of 31 patients (57.4% of the population), of whom 77.4% maintained compensatory hyperhidrosis. 93.5% reported to be highly satisfied with the surgical results and claimed to have improved their quality of life by 93.5%. 94% and 94.4% respectively of the patients evaluated in the medium term follow-up and after 3 months and in the medium term follow-up, recommend the surgery. CONCLUSION: Sympathectomy by video-assisted thoracoscopic surgery (VATS) is an effective and viable therapeutic option for primary focal hyperhidrosis patients. Despite compensatory hyperhidrosis being observed at time, this procedure produces very satisfactory results particularly in regard to the patient's post-operative quality of life.

Introdução: A Hiperidose Focal Primária afeta entre 1 a 4% da população, principalmente adolescentes e jovens- -adultos. É um distúrbio secundário a um excesso de estimulação simpática caracterizado por sudorese excessiva que pode envolver as mãos, a face, as axilas e os pés, representando um importante impacto negativo na qualidade de vida dos pacientes. A simpaticectomia vídeotoracoscópica é uma forma reconhecida de tratamento desta patologia. Este estudo tem como principal objetivo avaliar a qualidade de vida pós-cirúrgica dos pacientes submetidos a simpaticectomia por cirurgia toracoscópica videoassistida. Material e Métodos: Estudo retrospetivo de cinquenta e quatro pacientes com hiperidrose focal primária submetidos a simpaticectomia torácica por videotoracoscopia bilateral, na Clínica de Cirurgia Cardiotorácica da Casa de Saúde da Boavista, entre Janeiro de 2011 e Dezembro de 2014. Foram utilizados o questionário Quality of Life e a Hiperhidrosis Severity Scale na avaliação da qualidade de vida no pré-operatório e nos 3 meses após a cirurgia, bem como, a recolha de dados via telefónica num follow up a médio prazo. Todos os pacientes foram submetidos a anestesia geral e a técnica cirúrgica usada foi a secção da cadeia simpática bilateralmente por cirurgia vídeo-toracoscópica. Resultados: A maioria dos pacientes é do sexo feminino 59,2% (32). A idade média de idades é de 30,8 ± 7,70 (entre 16 e 49 anos). Antes da cirurgia, 85% dos pacientes apresentavam hiperidrose severa. O grau de desconforto geral promovido pela hiperidrose é de 79,6% sendo o domínio mais afetado o Funcional-Social (61,1%). Não houve complicações perioperatórias e pós-operatórias major. A taxa de complicações minor foi de 5,5%. Após 3 meses, obteve- -se um índice geral de 100% de melhoria na qualidade de vida dos pacientes e um grau de satisfação positivo de 96,3% apesar do aparecimento de hiperhidrose compensatória em 57,3% dos pacientes. O Domínio que apresentou melhorias significativas foi o Funcional-Social, em 55,5% dos pacientes. O follow up a médio prazo (média de 6 anos) permitiu avaliar 31 pacientes (57,4% da população) dos quais 77,4% mantém hiperhidrose compensatória. 93,5% Refere satisfação elevada com o resultado cirúrgico tendo melhorado a sua qualidade de vida em 93,5%. Dos pacientes avaliados no follow up a 3 meses e a médio prazo, 94,4% e 94,0% recomendam a cirurgia, respetivamente. Conclusão: A simpaticectomia por cirurgia toracoscópica videoassistida é uma opção terapêutica eficaz e viável da hiperidrose focal primária. Apesar da incidência de hiperidrose compensatória, é um procedimento bastante satisfatório no que respeita à qualidade de vida da grande maioria dos pacientes submetidos a este tipo de cirurgia.

Prevalencia de parasitosis intestinales en unidades educativas de Ciudad Bolívar, Venezuela / Prevalence of intestinal parasites in educational units from Ciudad Bolívar, Venezuela

Introducción: Las parasitosis intestinales a nivel mundial son un problema de salud pública que afecta a los países en las zonas tropicales. Un grupo muy vulnerable a padecer este tipo de infección son los niños. El objetivo de la presente investigación fue determinar la prevalencia general de parásitos intestinales en las Unidades Educativas de Ciudad Bolívar, entre los años 2009 - 2013. Materiales y Métodos: Fueron obtenidos los trabajos de grado sobre el tema del Departamento de Parasitología y Microbiología y así se recolectaron datos sobre edad, sexo, tipo de parasito, especies y asociaciones parasitarias y poder calcular así dicha prevalencia general. Resultados: Se encontró una prevalencia general de 63,1% sin predilección por la edad o sexo. Los tipos de parásitos más prevalentes fueron los protozoarios con 83,5%. Las especies más prevalentes fueron Blastocystis spp con 39,7%, Entamoeba coli con 15,3%, y Giardia intestinalis con 13,4%. Las asociaciones parasitarias más frecuentes Blastocystis sppconEndolimax nana (21,1%) yBlastocystis sppcon Entamoeba coli. (7,4%). Discusión: Los resultados de este estudio guardan relación con estudios realizados a nivel nacional como internacional, con respecto a las prevalencias de parasitosis, el predominio de protozoarios sobre helmintos en los últimos años, y la indistinción de la infección parasitaria con respecto al género. Conclusiones: La prevalencia aquí estudiada a manera general es alta, se recomienda seguir haciendo este tipo de estudios en escuelas para denotar el impacto de estas infecciones en niños y la consecuencia que esto conlleva.

Introduction: The intestinal parasites are a worldwide public health problem that affects countries in tropical and subtropical areas, a very vulnerable group to suffer this kind of infection are children .The objective of this investigation was determine the general prevalence of parasitism intestinal in the Educational Units from Ciudad Bolívar, between the years 2009 - 2013. Materials and Methods: For this were reviewed the degree work’s about intestinal parasitism’s in the Department of Parasitology and Microbiology , ando so data was collected about, age, sex, parasite type, species and parasitic association, and so calculate the general prevalence Results: It was found a general prevalence of 63,1% no predilection for the age or sex. The parasite types more prevalent have be the protozoan with 83, 5%. The species more prevalente heve be Blastocystis spp with 39, 7% Entamoeba coli with 15, 3%, and Giardia intestinalis 13, 4%. The parasitic association most frequent Blastocystis spp / Endolimax nana (21,1%) and Blastocystis spp / Entamoeba coli (7,4%). Discussion: The results of this study relate to the work done at national and international level regarding the prevalence of parasitosis, the predominance of protozoa with respect to helminths, and indistinction of parasitic infection with regard to gender. Conclusions: The prevalence in all years studied here assessed globally is high, it is recommended to keep doing this type of study in schools to denote the impact of these infections in children and the consequences that this entails.

[Complications in patients undergoing thoracotomy for lung carcinoma]. / Principais complicações do tratamento cirúrgico do cancro do pulmão.

Lung cancer is a common fatal disease, and fewer than 20% of all lung cancer patients are candidates for a curative resection. Major concerns, however, are the mortality and morbidity rates for pulmonary resection which remain significant.Despite the improvements in surgical techniques and perioperative patient management, postoperative cardiopulmonary complications still occur in 20%-30% of lung cancer surgical patients. Patients undergoing thoracotomy for lung carcinoma present a uniquely high risk group for pulmonary complications in particular. Histories of heavy smoking, chronic lung disease, coexisting medical conditions, and the nature of the procedure contribute. The spectrum of pulmonary complications may range from atelectasis and pneumonia to acute lung injury, with the most severe form being acute respiratory distress syndrome. This review was undertaken to evaluate and discuss major complications in patients undergoing thoracotomy for lung cancer.

Interstitial lung disease: diagnostic accuracy and safety of surgical lung biopsy.

This study reports our experience, diagnostic accuracy and safety of surgical lung biopsy in patients with interstitial lung diseases. From January 1998 - December 2007 surgical lung biopsy was performed in 53 patients (22 female [41.5%]; age 47.2+/-13 years). A total of 37 patients (69.8%) underwent videothoracoscopic lung biopsy and minithoracotomy was performed in 16 patients (30.2%). Right lung was the choice in 47 patients (88.7%). Postoperative complications were rare (9.4%) and included three prolonged air leaks (5.7%), one pneumothorax requiring a chest drain (1.9%), and one haemothorax requiring reoperation (1.9%). One patient died of cardiac arrest of unknown cause. Average chest tube duration was 4.4+/-3 days and average hospital stay 5.4+/-4 days. Lung biopsy contributed to the diagnosis in 50 patients (94.3%). In conclusion, the potential benefits of diagnostic surgical lung biopsy must be considered against the risks of the procedure especially in patients with severe cardiopulmonary dysfunction.

[Indications and results of lung resection in bronchiectasis]. / O papel da ressecção pulmonary no tratamento das bronquiectasias.

The prevalence of bronchiectasis has decreased significantly over recent decades in developed countries. However, resection for bronchiectasis still plays an important role in thoracic surgery practice in some countries such as Portugal. Between 1994 and 2004, 51 patients (29 female and 22 male) with a mean age of 38.6 years (range, 4-65 years) underwent pulmonary resection for bronchiectasis. Mean duration of symptoms was 4.8 years. Surgery was indicated because of unsuccessful medical therapy in 25 patients (49.1%), hemoptysis in 12 (23.5%), lung mass in 9 (17.6%) and lung abscess in 5 (9.8%). The surgical treatment was as follows: pneumectomy in 7 patients, bilobectomy in 3, lobectomy in 36 segmentectomy in 5. There was no operative mortality. Complications occurred in 8 patients and the morbidity rate was 15.7%. Follow-up was complete in 45 (88.2%) patients with a mean of 3.4 years. Overall, 35 (77.7%) patients were asymptomatic after surgery symptoms were improved in 7 (15.6%). Unsuccessful medical therapy was still our main indication for surgery of bronchiectasis, despite aggressive antibiotic therapy. Surgical resection was performed with acceptable morbidity and morbility rates and markedly improved symptoms in the majority of patients.

[A case of recurrent spontaneous pneumothorax]. / Um caso de pneumotórax espontâneo recorrente.

Spontaneous pneumothorax is a rare disease at paediatric age and in most cases is associated to predisposing factors. The authors present a case of spontaneous pneumothorax in a 9 year-old child with a history of prematurity and mechanical ventilation at neonatal stage. In spite of clinical and radiological improvement after pleural drainage, pneumothorax recurred three months later and emphysema was identified, leading to surgery. This case is important due to the rarity of the disease in this age group and its possible relation to prior neonatal medical history.

Impact of isolated bypass grafting of the left internal thoracic artery to the left anterior descending coronary artery in high-risk patients with three-vessel coronary artery disease.

INTRODUCTION: Multiple strategies to achieve some degree of myocardial revascularization are available. In some, less complete revascularization is accepted to limit invasiveness, mostly in older, high-risk patients and patients with unsuitable coronary anatomy. METHODS: Patient and operative data were collected retrospectively for all patients with three-vessel coronary artery disease who had off-pump coronary artery bypass surgery from January 2003 through December 2005. In-hospital outcomes, preoperative risk, survival and postoperative complications were compared between patients with complete (n = 89) and incomplete (n = 61) revascularization. RESULTS: The mean follow-up was 20.2 +/- 4.6 months. Patients with incomplete revascularization tended to be older (76.8 +/- 1.4 years) than those with complete revascularization (66.3 +/- 1.0 years) and were more likely to have diabetes (43% versus 30%), cerebrovascular disease (18% versus 11%) and peripheral arterial disease (20% versus 9%), poorer ejection fraction (34.7 +/- 1.7% versus 50.8 +/- 1.5%) and greater EuroSCORE risk (9.7 +/- 2.1 vs. 5.1 +/- 1.3). In-hospital (3.3% versus 3.4%) and 6-month (4.9% versus 5.6%) mortality were not statistically different in the two groups, nor was recurrence of angina (3.3% versus 1.1%) or need for repeat revascularization (percutaneous or surgical) (4.9% versus 3.3%). CONCLUSION: In high-risk patients with three-vessel coronary artery disease, the potential benefits of less invasive surgery should be considered. Surgical outcomes depend on preoperative condition rather than incomplete revascularization. Medium-term mortality and cardiac-related events associated with this surgical strategy are not increased.

[Surgical treatment of bronchiectasis]. / Tratamento cirúrgico das bronquiectasias.

While the prevalence of bronchiectasis has decreased significantly over recent decades in developed countries, resection for bronchiectasis still plays an important part in thoracic surgery practice in some countries, such as Portugal. Between 1994 and 2004, 51 patients (29 female and 22 male) with a mean age of 38.6 years (range 4-65 years) underwent pulmonary resection for bronchiectasis. Mean duration of symptoms was 4.8 years. Surgery was indicated because of unsuccessful medical therapy in 25 patients (49.1%), haemoptysis in 12 (23.5%), lung mass in 9 (17.6%) and lung abscess in 5 (9.8%). The surgical treatment was pulmonectomy in 7 patients, bilobectomy in 3, lobectomy in 36 and segmentectomy in 5. There was no operative mortality. Complications occurred in 8 patients and the morbidity rate was 15.7%. Follow-up was complete in 45 (88.2%) patients with a mean of 3.4 years. Overall, 35 (77.7%) patients were asymptomatic after surgery, symptoms were improved in 7 (15.6%), and unchanged or worse in 3 (6.7%). Unsuccessful medical therapy was still our main indication for surgery of bronchiectasis, despite aggressive anti- biotic therapy. Surgical resection was performed with acceptable morbidity and morbidity and markedly improved symptoms in the majority of patients.

Bronchopulmonary sequestration--a 12-year experience.

Bronchopulmonary sequestration (BPS) is a rare malformation of the lower respiratory tract. It consists of a non-functioning mass of lung tissue that lacks normal communication with the tracheobronchial tree and that receives arterial blood supply from the systemic circulation. It is classified as intralobar (ILS) or extralobar (ELS) according to its location within or outside the normal lung. Most sequestrations are intralobar (75%) and occur predominantly in the left lower lobe.

[Carney's Complex: familial cardiac myxoma]. / Complexo de Carney: mixoma cardíaco familiar.

The Carney Complex is a very rare autosomal dominant disease including multiple neoplasia syndrome. This syndrome was initially described in 1985 under the rubric "...the complex of myxomas, spotty pigmentation, and endocrine overactivity". We present a case report of an old woman with Carney Complex who had the characteristic features of facial hirsutism and acromegalic facies, a large pigmented swelling over the face and a cardiac myxoma arising from the left atrium. We emphasize the need for periodic echocardiographic screening of patients and family members.

[Transaortic resection of left ventricular fibroelastoma]. / Exerese transaórtica de fibroelastoma do ventrícular esquerda.

Left ventricular tumors are extremely rare. Complete surgical resection is usually curative and recurrence is rare. The left atrial approach is safe and advisable when possible. We report a rare case of left ventricular tumor in a 71-year-old man presented with a cerebellar stroke. A two-dimensional echocardiogram revealed a mobile mass with the stalk attached deeply in left ventricular wall. To improve surgical access, a transversal aortotomy was performed and the mass was gently pulled and excised. Intracavitary left ventricular tumors, which are deeply situated, difficult to see, and inaccessible via left atriotomy, may be made surgically accessible by a transaortic approach. A vetriculotomy should be avoided.

[Iatrogenic tracheal rupture: a case report and indications for conservative management]. / Ruptura iatrogénica da traqueia: caso clínico e indicações para tratamento conservador.

Tracheal rupture after endotracheal intubation requires immediate intervention. There have been an increasing number of reports that describe nonsurgical management of this issue. We report the case of a 47-year-old woman who experienced an iatrogenic tracheal rupture during endotracheal intubation for a surgical procedure with general anaesthesia. She was successfully managed conservatively with a broad-spectrum antibiotic. We managed it non-operatively, because the patient had a small tear, was hemodynamically stable, show no evidence of infection or respiratory failure, and the diagnosis was not immediate. Bronchoscopy was a good diagnostic tool and it was used to make decisions regarding conservative management, and to detect granulation tissue and rule out any tracheal stenosis after treatment. We review available literature on conservative management of tracheal rupture. Immediate recognition and adequate treatment are very important in managing this potentially fatal situation. The final decision should be based on clinical, radiologic and bronchoscopic findings.

Informe sobre el asesoramiento prestado al servicio nacional de tuberculosis del Ministerio de Previsión Social y Salud Pública de Bolivia del 22 de mayo al 5 de junio de 1982 / sss

Los objetivos del presente asesoramiento son: Elaboración del modelo de programación local de actividades de lucha antituberculosa. Revisión de las normas del programa