ABSTRACT
A female newborn presented with respiratory distress at birth and was diagnosed with congenital tracheal stenosis. The stenosis was positioned at the distal trachea and compromised the carina and the right and left bronchi. She underwent surgical treatment using circulatory life support with veno-arterial peripheral extracorporeal membrane oxygenation, and the airway was reconstructed using the slide tracheoplasty technique to build a neocarina. The patient had an excellent postoperative course, was successfully weaned from extracorporeal membrane oxygenation and invasive ventilation, and was discharged.
Subject(s)
Bronchi , Extracorporeal Membrane Oxygenation , Plastic Surgery Procedures , Trachea , Tracheal Stenosis , Humans , Female , Tracheal Stenosis/surgery , Tracheal Stenosis/congenital , Tracheal Stenosis/diagnostic imaging , Infant, Newborn , Trachea/surgery , Trachea/abnormalities , Trachea/diagnostic imaging , Extracorporeal Membrane Oxygenation/methods , Bronchi/surgery , Bronchi/abnormalities , Bronchi/diagnostic imaging , Plastic Surgery Procedures/methods , Treatment OutcomeABSTRACT
ABSTRACT A female newborn presented with respiratory distress at birth and was diagnosed with congenital tracheal stenosis. The stenosis was positioned at the distal trachea and compromised the carina and the right and left bronchi. She underwent surgical treatment using circulatory life support with veno-arterial peripheral extracorporeal membrane oxygenation, and the airway was reconstructed using the slide tracheoplasty technique to build a neocarina. The patient had an excellent postoperative course, was successfully weaned from extracorporeal membrane oxygenation and invasive ventilation, and was discharged.
Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Decision Making/ethics , Pandemics , Pneumonia, Viral/therapy , Resource Allocation/methods , Triage/methods , COVID-19 , Coronavirus Infections/economics , Humans , Pandemics/economics , Pandemics/ethics , Pneumonia, Viral/economics , Resource Allocation/ethics , SARS-CoV-2 , Triage/ethicsSubject(s)
Lung Diseases/etiology , Pleural Effusion/complications , Torsion Abnormality/etiology , Comorbidity , Humans , Liver Cirrhosis/epidemiology , Lung Diseases/surgery , Male , Middle Aged , Middle Lobe Syndrome/complications , Middle Lobe Syndrome/diagnostic imaging , Middle Lobe Syndrome/epidemiology , Middle Lobe Syndrome/surgery , Pneumonectomy , Recurrence , Tomography, X-Ray Computed , Torsion Abnormality/epidemiology , Torsion Abnormality/surgeryABSTRACT
Lung transplantation is a globally accepted treatment for some advanced lung diseases, giving the recipients longer survival and better quality of life. Since the first transplant successfully performed in 1983, more than 40 thousand transplants have been performed worldwide. Of these, about seven hundred were in Brazil. However, survival of the transplant is less than desired, with a high mortality rate related to primary graft dysfunction, infection, and chronic graft dysfunction, particularly in the form of bronchiolitis obliterans syndrome. New technologies have been developed to improve the various stages of lung transplant. To increase the supply of lungs, ex vivo lung reconditioning has been used in some countries, including Brazil. For advanced life support in the perioperative period, extracorporeal membrane oxygenation and hemodynamic support equipment have been used as a bridge to transplant in critically ill patients on the waiting list, and to keep patients alive until resolution of the primary dysfunction after graft transplant. There are patients requiring lung transplant in Brazil who do not even come to the point of being referred to a transplant center because there are only seven such centers active in the country. It is urgent to create new centers capable of performing lung transplantation to provide patients with some advanced forms of lung disease a chance to live longer and with better quality of life.
Subject(s)
Idiopathic Pulmonary Fibrosis/surgery , Lung Transplantation/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/surgery , Age Factors , Brazil , Cause of Death , Contraindications , Donor Selection , Graft Rejection/prevention & control , Humans , Lung Transplantation/methods , Lung Transplantation/mortality , Perioperative Period , Risk Assessment , Survival Analysis , Waiting ListsABSTRACT
ABSTRACT Lung transplantation is a globally accepted treatment for some advanced lung diseases, giving the recipients longer survival and better quality of life. Since the first transplant successfully performed in 1983, more than 40 thousand transplants have been performed worldwide. Of these, about seven hundred were in Brazil. However, survival of the transplant is less than desired, with a high mortality rate related to primary graft dysfunction, infection, and chronic graft dysfunction, particularly in the form of bronchiolitis obliterans syndrome. New technologies have been developed to improve the various stages of lung transplant. To increase the supply of lungs, ex vivo lung reconditioning has been used in some countries, including Brazil. For advanced life support in the perioperative period, extracorporeal membrane oxygenation and hemodynamic support equipment have been used as a bridge to transplant in critically ill patients on the waiting list, and to keep patients alive until resolution of the primary dysfunction after graft transplant. There are patients requiring lung transplant in Brazil who do not even come to the point of being referred to a transplant center because there are only seven such centers active in the country. It is urgent to create new centers capable of performing lung transplantation to provide patients with some advanced forms of lung disease a chance to live longer and with better quality of life.
RESUMO O transplante pulmonar é um tratamento mundialmente aceito para alguma pneumopatias avançadas, conferindo aos receptores maior sobrevida e melhor qualidade de vida. Desde o primeiro transplante realizado com sucesso em 1983, mais de 40 mil transplantes foram feitos em todo mundo. Destes, cerca de 700 foram no Brasil. No entanto, a sobrevida do transplante é menor do que a desejada, com altos índices de mortalidade relacionados à disfunção primária do enxerto, infecções e disfunção crônica do enxerto, principalmente sob a forma da síndrome da bronquiolite obliterante. Novas tecnologias têm sido desenvolvidas para aprimoramento das diversas etapas do transplante pulmonar. Para aumentar a oferta de pulmões, o recondicionamento pulmonar ex vivo vem sendo utilizado em alguns países, inclusive no Brasil. Para suporte avançado de vida no período perioperatório, equipamentos de oxigenação extracorpórea e de suporte hemodinâmico vêm sendo utilizado como ponte para o transplante em pacientes gravemente doentes em lista de espera e para manter pacientes vivos até a resolução da disfunção primária do enxerto pós-transplante. Existe uma demanda reprimida de pacientes que necessitam de transplante pulmonar no Brasil e que nem sequer chegam a ser encaminhados a um centro transplantador, pois só existem sete deles ativos no país. É urgente a criação de novos centros capazes de realizar transplante pulmonar para oferecer a pacientes com algumas pneumopatias avançadas uma chance de viver mais e com melhor qualidade de vida.
Subject(s)
Humans , Lung Transplantation/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/surgery , Idiopathic Pulmonary Fibrosis/surgery , Brazil , Survival Analysis , Cause of Death , Waiting Lists , Age Factors , Lung Transplantation/methods , Lung Transplantation/mortality , Risk Assessment , Donor Selection , Perioperative Period , Contraindications , Graft Rejection/prevention & controlABSTRACT
Embora ainda persistam dúvidas quanto à assinatura eletrônica, certificação digital e outras questões de credibilidade, tudo indica que as boas experiências venham a promover uma das maiores revoluções referentes ao cuidado com o paciente, além de possibilitar a utilização de informações para uso peda¬gógico e científico. Acreditamos que as primeiras pegadas em direção ao futuro do prontuário eletrônico do paciente tenham sido bastante promissoras.
Subject(s)
Medical Records Systems, Computerized/trends , Medical Records Systems, ComputerizedABSTRACT
Small animal models are particularly suitable for lung preservation studies, because they are simple and cost-effective. This brief communication focuses on the technical description of an ex vivo lung perfusion model in rats by means of a commercially available apparatus, which was the first to be installed in a thoracic surgery research laboratory in Brazil. The model and its preparation, together with its applications for lung preservation studies, are described in detail. All technical details can also be seen in a video posted on the website of the Brazilian Journal of Pulmonology.
Subject(s)
Lung , Organ Preservation/methods , Perfusion/methods , Animals , Lung Transplantation , Male , Random Allocation , RatsABSTRACT
Estudos de preservação pulmonar em modelos experimentais realizados em animais de pequeno porte são de realização mais simples e barata. Esta comunicação tem o enfoque de descrever tecnicamente um modelo de perfusão pulmonar ex vivo em ratos, com o uso de um equipamento disponível comercialmente que foi o primeiro a ser instalado em um laboratório de pesquisa em cirurgia torácica no Brasil. Descrevemos detalhadamente o modelo e sua preparação, assim como suas aplicações para estudos de preservação pulmonar. Os detalhes técnicos da preparação podem ser observados também em um vídeo postado no site do Jornal Brasileiro de Pneumologia.
Small animal models are particularly suitable for lung preservation studies, because they are simple and cost-effective. This brief communication focuses on the technical description of an ex vivo lung perfusion model in rats by means of a commercially available apparatus, which was the first to be installed in a thoracic surgery research laboratory in Brazil. The model and its preparation, together with its applications for lung preservation studies, are described in detail. All technical details can also be seen in a video posted on the website of the Brazilian Journal of Pulmonology.
Subject(s)
Animals , Male , Rats , Lung , Organ Preservation/methods , Perfusion/methods , Lung Transplantation , Random AllocationABSTRACT
We present a case of the successful repair of an iatrogenic central vein lesion using a videothoracoscopic approach. The confluence of the right innominate vein and the superior vena cava was perforated during the placement of a right internal jugular vein long-term dialysis catheter. The misplacement of the tips of the catheter in the right pleural space was promptly observed. The catheter was removed under pleural videothoracoscopic vision while a tamponade was directly applied to the mediastinal perforation. Massive bleeding was prevented and the central vein perforation was treated successfully using a minimally invasive technique.
Subject(s)
Brachiocephalic Veins/surgery , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Hemorrhage/surgery , Hemostatic Techniques , Renal Dialysis , Thoracic Surgery, Video-Assisted , Vena Cava, Superior/surgery , Wounds, Penetrating/surgery , Brachiocephalic Veins/injuries , Catheterization, Central Venous/instrumentation , Hemorrhage/etiology , Humans , Iatrogenic Disease , Male , Middle Aged , Polycystic Kidney Diseases/complications , Polycystic Kidney Diseases/therapy , Renal Insufficiency/etiology , Renal Insufficiency/therapy , Rupture , Treatment Outcome , Vena Cava, Superior/injuries , Wounds, Penetrating/etiologyABSTRACT
In the last 20 years, lung transplantation has become the standard treatment for patients with end-stage lung disease. However, less than 20% of the donor lungs available for transplant are actually usable. This disparity between the growing number of recipients and the small number of donors has resulted in increased mortality among lung transplant candidates on waiting lists. Strategies such as the utilization of organs from marginal donors have proven ineffective in increasing the number of transplants. In 2000, a new method for reconditioning human lungs that had been previously rejected for transplantation was developed in Sweden. We describe our initial experience with ex vivo lung perfusion.
Subject(s)
Lung Transplantation , Lung , Organ Preservation/methods , Perfusion/methods , Aged , Brazil , Donor Selection , Humans , Middle Aged , Perfusion/instrumentationABSTRACT
Nos últimos 20 anos, o transplante pulmonar tornou-se o tratamento padrão para algumas pneumopatias graves em estágio terminal. Menos de 20 por cento dos pulmões doados para transplante são realmente utilizados. Essa desproporção entre o crescente número de candidatos ao transplante pulmonar e o reduzido número de doadores resulta em aumento da mortalidade nas filas de espera. Estratégias, como o uso de órgãos de doadores marginais, não se mostraram efetivas em aumentar o número de transplantes. Em 2000, na Suécia, foi desenvolvido um método novo para recondicionar pulmões humanos rejeitados para transplante. Descrevemos nossa experiência inicial com a perfusão pulmonar ex vivo.
In the last 20 years, lung transplantation has become the standard treatment for patients with end-stage lung disease. However, less than 20 percent of the donor lungs available for transplant are actually usable. This disparity between the growing number of recipients and the small number of donors has resulted in increased mortality among lung transplant candidates on waiting lists. Strategies such as the utilization of organs from marginal donors have proven ineffective in increasing the number of transplants. In 2000, a new method for reconditioning human lungs that had been previously rejected for transplantation was developed in Sweden. We describe our initial experience with ex vivo lung perfusion.
Subject(s)
Aged , Humans , Middle Aged , Lung , Lung Transplantation , Organ Preservation/methods , Perfusion/methods , Brazil , Donor Selection , Perfusion/instrumentationABSTRACT
RFC, mulher de 85 anos com desconforto em hemitórax direito. Atomografia de tórax na admissão demonstrou derrame pleural diretoe a videotoracoscopia identificou hematomas traumáticos semoutras lesões. O trauma é um diagnóstico diferencial de derramespleurais eosinofílicos. A videotoracoscopia tem sido preconizadacomo procedimento de escolha para diagnósticos diferenciais emderrames pleurais.
Subject(s)
Humans , Female , Aged, 80 and over , Diagnosis, Differential , Hematoma , Pleural Effusion , Pulmonary Eosinophilia , Thoracic Surgery, Video-AssistedABSTRACT
OBJETIVO: Verificar o impacto dos resultados da biópsia pulmonar a céu aberto nas decisões que determinem mudanças nas estratégias de tratamento de pacientes críticos, com infiltrados pulmonares difusos e insuficiência respiratória aguda refratária, bem como na melhora de seu quadro clínico. MÉTODOS: Foram avaliados 12 pacientes com insuficiência respiratória aguda e sob ventilação mecânica, que foram submetidos à biópsia pulmonar a céu aberto (por toracotomia) após a ausência de resposta clínica ao tratamento padrão. RESULTADOS: A maior causa isolada de insuficiência respiratória aguda foi a infecção viral, identificada em 5 pacientes (40 por cento). A avaliação pré-operatória da causa da insuficiência respiratória foi modificada em 11 pacientes (91,6 por cento), e um diagnóstico específico foi feito em 100 por cento dos casos. A taxa de mortalidade foi de 50 por cento, a despeito das mudanças no regime terapêutico. Seis pacientes (50 por cento) sobreviveram e obtiveram alta hospitalar. Todos os pacientes que obtiveram alta sobreviveram por pelo menos um ano após a biópsia pulmonar a céu aberto, totalizando uma taxa de sobrevida em um ano de 50 por cento dentre os 12 pacientes estudados. Quanto aos pacientes que faleceram no hospital, o tempo de sobrevida após a biópsia pulmonar a céu aberto foi de 14 + 10,8 dias. CONCLUSÃO: Concluímos que a biópsia pulmonar a céu aberto é uma ferramenta útil no controle da insuficiência respiratória aguda quando não se observa melhora clínica após o tratamento padrão, já que pode resultar em um diagnóstico específico que requeira tratamento distinto, provavelmente diminuindo a taxa de mortalidade desses pacientes.
OBJECTIVE: To determine the impact that open lung biopsy findings have on decisions regarding changes in the treatment strategies employed for critically ill patients presenting diffuse pulmonary infiltrates and suffering from refractory acute respiratory failure, as well as on their clinical improvement. METHODS: This study involved 12 mechanically ventilated patients with acute respiratory failure who were subjected to open lung biopsy (by thoracotomy) after not presenting a clinical response to standard treatment. RESULTS: The single most common cause of the acute respiratory failure was viral infection, which was identified in 5 patients (40 percent). The pre-operative evaluation of the cause of respiratory failure was modified in 11 patients (91.6 percent), and a specific diagnosis was made in 100 percent of the cases. Regardless of changes in treatment regimen, the mortality rate was 50 percent. Six patients (50 percent) survived to be discharged from the hospital. All of the discharged patients survived for at least one year after the open lung biopsy, for an overall one-year survival rate of 50 percent among the 12 patients studied. For the patients who died in the hospital, the time of survival after open lung biopsy was 14 + 10.8 days. CONCLUSION: We conclude that open lung biopsy is a useful tool in the management of acute respiratory failure when there is no clinical improvement after standard treatment, since it can lead to a specific diagnosis that requires distinct treatment, which probably lowers the mortality rate among such patients.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Biopsy/methods , Lung Diseases/pathology , Lung/pathology , Respiratory Insufficiency/pathology , Acute Disease , Critical Illness , Lung Diseases/mortality , Reproducibility of Results , Respiration, Artificial , Retrospective Studies , Respiratory Insufficiency/etiology , Respiratory Insufficiency/mortalityABSTRACT
BACKGROUND: Different techniques of video-assisted thoracic sympathectomy have been suggested to control the symptoms of axillary hyperhidrosis. We compared the results using two different levels of ganglion resection for treating axillary hyperhidrosis: T3/T4 vs. T4. MATERIALS AND METHODS: From a group of 1119 patients operated on between July 2000 and January 2005, 276 patients with axillary hyperhidrosis were studied. The mean age was 26 (range, 13-54 years) and 61.6% were female. Of these patients, 216 (78.3%) were treated with thermal ablation of T3/T4 and 60 (21.7%) with thermal ablation of T4 alone. The procedures were bilateral and simultaneous, using two 5.5-mm trocars and 30-degree optical systems, under general anesthesia in all cases. RESULTS: There was no mortality and no important postoperative complications or need to convert to thoracotomy in either group. The mean follow-up in the T4 group was 11 months (range, 2-23 months) and in the T3/T4 group mean follow-up was 24 months (range, 13-54 months). The immediate therapeutic success rate was 100% in both groups. There were recurrences in 7 (2.5%) patients, all from the T3/T4 group. The satisfaction rate was higher and more stable in the T4 group and compensatory sweating was lower in the T4 group. CONCLUSION: Both techniques proved effective for controlling the axillary symptoms. Group T4 presented a higher satisfaction rate, lower recurrence rate, and lower severity of compensatory sweating.
Subject(s)
Hyperhidrosis/surgery , Sympathectomy/methods , Thoracic Nerves/surgery , Thoracic Surgery, Video-Assisted , Adolescent , Adult , Axilla , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Satisfaction , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To determine the impact that open lung biopsy findings have on decisions regarding changes in the treatment strategies employed for critically ill patients presenting diffuse pulmonary infiltrates and suffering from refractory acute respiratory failure, as well as on their clinical improvement. METHODS: This study involved 12 mechanically ventilated patients with acute respiratory failure who were subjected to open lung biopsy (by thoracotomy) after not presenting a clinical response to standard treatment. RESULTS: The single most common cause of the acute respiratory failure was viral infection, which was identified in 5 patients (40%). The pre-operative evaluation of the cause of respiratory failure was modified in 11 patients (91.6%), and a specific diagnosis was made in 100% of the cases. Regardless of changes in treatment regimen, the mortality rate was 50%. Six patients (50%) survived to be discharged from the hospital. All of the discharged patients survived for at least one year after the open lung biopsy, for an overall one-year survival rate of 50% among the 12 patients studied. For the patients who died in the hospital, the time of survival after open lung biopsy was 14 + 10.8 days. CONCLUSION: We conclude that open lung biopsy is a useful tool in the management of acute respiratory failure when there is no clinical improvement after standard treatment, since it can lead to a specific diagnosis that requires distinct treatment, which probably lowers the mortality rate among such patients.
