Heart-shaped Mediastinal Angiomyolipoma With Chylopericardium.

Angiomyolipomas are benign mesenchymal tumors classified as PEComas, consisting of blood vessels, smooth muscle, and fat, and generally found in renal tissue. Extrarenal cases are uncommon, and those of the mediastinum are rare, with only 23 reports in the literature. We present a successful surgically managed case of a symptomatic 44-year-old woman with a large heart-shaped mediastinal angiomyolipoma in the right hemithorax associated with chylopericardium.

Anatomical and developmental aspects of iatrogenic injury to the right recurrent laryngeal nerve in surgical resections of substernal goiter.

Thyroid surgery is the primary treatment for substernal goiters, and iatrogenic injury to the recurrent laryngeal nerve (RNL) is always a risk. The literature suggests that iatrogenic lesions of the RNL post resection of substernal goiter are not equally distributed, being more frequent on the right recurrent laryngeal nerve (R-RLN) in comparison to the left recurrent laryngeal nerve (L-RLN). The relative paucity of basic anatomical and clinical reportages on R-RLN iatrogenic injuries and on the developmental factors that may help explain its higher incidence justifies this study's undertaking. Here we compare incidence of right versus left iatrogenic injuries to the RLN in surgical resections of substernal goiters and discuss the anatomical and embryological factors involved. This report is part of a larger retrospective observational cohort study of 239 patients surgically treated for substernal goiter in the Gaffrée and Guinle University Hospital, Rio de Janeiro, from 2006 to 2018. From 239 patients, 13 presented with iatrogenic RLN injury, one patient presented bilateral lesion, totalling 15 iatrogenic lesions. Our analysis showed that the R-RLN seems to be anatomically more vulnerable to injury due to the embryological underpinnings addressed in this review, R-RLN = 64.29% (n = 9) and L-RLN = 35.71% (n = 5). Pathological factors like malignancy and size of the mass are relevant issues to be considered. The knowledge of anatomical landmarks and embryological development of the thyroid and associated structures can improve our understanding and teaching of surgical anatomy, thus helping prevent and reduce the number of iatrogenic injuries on right RLNs.

Primary hyperhidrosis prevalence and characteristics among medical students in Rio de Janeiro.

BACKGROUND: Hyperhidrosis is a pathological condition defined by excessive sweating beyond thermoregulatory physiological needs, which can cause substantial psychological impact and impairment of daily activities. Studies regarding its prevalence, however, are scarce and vary widely in their findings. The population of medical students is a particularly interesting subset for its recurring demand of physical contact during patient examination or procedures, and the potential for professional adversity. We aimed at furthering the comprehension of this disease prevalence and characteristics among medical students. METHODS: Questionnaires inquiring about the presence and characteristics of Primary Hyperhidrosis (PH) were applied through either written or digital means to all eligible medical students enrolled in three Medical Schools in the State of Rio de Janeiro who agreed to take part in the study. Demographic data regarding gender, ethnicity, current age, weight and height was collected in addition to clinical data (sweat site, age of onset, familial history, severity and previous treatments). Severity was evaluated through the Hyperhidrosis Disease Severity Scale (HDSS) and a symptoms survey. FINDINGS: Our response rate was roughly 1/3 of all eligible students (900/2700). PH prevalence was 20.56% (185/900). It was similar between men and women (23.08% and 19.41%, respectively) and strongly associated with family history of the disease (Prevalence Ratio of 4.27). Regarding ethnicity, of the total sample 73.78% (664/900) self-declared white, among which 19.28% (128/664) had PH. Mixed-race and other ethnicities encompassed 26.22% (236/900) of the sample, among which 24.15% (57/236) had PH. Most positive subjects (64.32%) presented associated forms of PH. Overall involvement of each site (both associated and isolated) was: 63.78% axillary, 50.81% palmar, 43.24% plantar, 20.54% craniofacial, 18.38% facial flushing and 2.16% gustatory sweating. Mean current age was 23.11(±4.04) years for PH patients, and age of onset was ≤18 years in 93.94% of cases. Regarding body mass index (BMI), 71.09% of PH patients had BMI<25kg/m2 and only 4.69% presented BMI≥30kg/m2, none ≥35kg/m2. Some degree of life quality impairment was reported by 89.20% of PH patients, and 23.89% had HDSS 3 or 4 (moderate to severe). CONCLUSIONS: PH prevalence among Rio de Janeiro medical students was 20.56%, similar between men and women, predominating associated presentations, axillary, palmar and plantar sites, strong familial history, age of onset before 18 years, and some degree of life impairment.

Evaluation of the quality of life of patients with primary hyperhidrosis submitted to videothoracoscopic sympathectomy. / Avaliação da qualidade de vida de pacientes portadores de hiperidrose primária submetidos à simpatectomia videotoracoscópica.

OBJECTIVE: to evaluate the quality of life of patients undergoing video-assisted thoracoscopy for primary hyperhidrosis. METHODS: we evaluated the patients who underwent thoracoscopic sympathectomy to treat primary hyperhidrosis by the team of thoracic surgery at the University Hospital Gaffrée and Guinle - UNIRIO between July 2004 and August 2013. It was applied a questionnaire about quality of life related to hyperhidrosis since preoperative period until one year after the surgery. RESULTS: one hundred twenty two patients answered the questionnaire, with a mean age of 25 years, 57% of whom were women. In relation to severity of primary hyperhidrosis, 83% of the patients reported as tolerable or somewhat tolerable associated with major limitation of quality of life, which it was poor or very poor in 82% of cases. Postoperative compensatory hyperhidrosis occurred in 78% of patients, but it was regarded as invisible or barely noticeable for 85% of these patients, classifying it as acceptable. In 15% of patients, the compensatory sweating was classified as disruptive. CONCLUSION: thoracoscopic sympathectomy improves the quality of life of patients with primary hyperhidrosis. The transitional compensatory hyperhidrosis occurred in most patients, but did not improve significantly the quality of life.

OBJETIVO: avaliar a qualidade de vida de pacientes submetidos à simpatectomia por videotoracoscopia para tratamento de hiperidrose primária. MÉTODOS: foram avaliados os pacientes submetidos à simpatectomia por videotoracoscopia para tratamento de hiperidrose primária pela equipe de cirurgia torácica do Hospital Universitário Gafrée e Guinle-UNIRIO entre julho de 2004 e agosto de 2013. Foi aplicado um questionário sobre qualidade de vida relacionada à hiperidrose desde o pré-operatório até um ano após a operação. RESULTADOS: o questionário foi aplicado em 122 pacientes com média de idade de 25 anos, sendo 57% mulheres. Quanto à severidade da hiperidrose primária, 83% dos pacientes referiam como pouco tolerável ou intolerável, associada com grande limitação da qualidade de vida, sendo esta pobre ou muito pobre em 82% dos casos. No pós operatório a hiperidrose compensatória ocorreu em 78% dos pacientes, entretanto foi considerada como imperceptível ou pouco perceptível por 85% destes pacientes, classificando-a como aceitável. Em 15% dos pacientes a hiperidrose compensatória foi classificada como perturbadora. CONCLUSÃO: a simpatectomia videotoracoscópica melhora a qualidade de vida dos pacientes com hiperidrose primária. A hiperidrose compensatória transitória ocorreu na maioria dos pacientes, mas não alterou de maneira significativa a melhora da qualidade de vida.

Video-thoracoscopic approach, without suture, of late thoracic esophageal perforations. / Abordagem vídeo-toracoscópica, sem sutura, das perfurações do esôfago torácico diagnosticadas tardiamente.

OBJECTIVES: to evaluate the use of video-thoracoscopy, in the treatment of late perforations of the thoracic esophagus, without suture or organ resection. METHODS: retrospective analysis of patients with late diagnosis (> 12 hours) of thoracic esophageal perforation treated by video-thoracoscopy, without suture or organ resection, over a 15-year period. RESULTS: sixteen patients were operated on, ten men and six women, aged between 48 and 66 years, with time between the diagnosis of the perforation and the surgery ranging from 16 to 26 hours. All patients underwent video-thoracoscopy, with pulmonary decortication, pleural loculations approach, opening of the mediastinal pleura near the perforation site and debridement of the devitalized tissues, followed by double drainage of the pleural cavity. No esophageal suture or resection was performed, and the patients evolved with complete closure of the lesions, without deaths. CONCLUSION: the video-thoracoscopic surgical approach was able to control pleural infection, pulmonary expansion and enable complete regeneration of the esophagus with late-diagnosed perforation.

OBJETIVOS: avaliar a utilização da vídeo-toracoscopia, no tratamento das perfurações tardias do esôfago torácico, sem sutura ou ressecção do órgão. MÉTODOS: análise retrospectiva de pacientes com diagnóstico tardio (>12 horas) de perfuração do esôfago torácico tratados por vídeo-toracoscopia, sem sutura ou ressecção do órgão, num período de 15 anos. RESULTADOS: foram operados 16 pacientes, sendo dez homens e seis mulheres, com idades entre 48 e 66 anos e com tempo entre o diagnóstico da perfuração e a cirurgia variando entre 16 e 26 horas. Todos os pacientes foram submetidos a vídeo-toracoscopia, com decorticação pulmonar, abordagem das loculações pleurais, abertura da pleura mediastinal junto ao local da perfuração e desbridamento dos tecidos desvitalizados, seguido por dupla drenagem da cavidade pleural. Não foi realizada sutura ou ressecção esofagiana, e os pacientes evoluíram com fechamento completo das lesões, sem óbitos. CONCLUSÃO: a abordagem cirúrgica vídeo-toracoscópica mostrou-se capaz de controlar a infecção pleural, a expansão pulmonar e possibilitar a completa regeneração do esôfago com perfuração diagnosticada tardiamente.

Thoraco-laparoscopic esophagectomy: thoracic stage in prone position.

OBJECTIVE: to analyze the National Cancer Institute Abdominopelvic Division (INCA / MS/HC I) initial experience with thoraco-laparoscopic esophagectomy with thoracic stage in prone position. METHODS: we studied 19 consecutive thoraco-laparoscopic esophagectomies from may 2012 to august 2014, including ten patients with squamous cells carcinoma (five of the middle third and five of the lower third) and nine cases of gastroesophageal junction adenocarcinoma (six Siewert I and three Siewert II). All procedures were initiated by the prone thoracic stage. RESULTS: There were minimal blood loss, optimal mediastinal visualization, oncological radicality and no conversions. Surgical morbidity was 42 %, most being minor complications (58% Clavien I or II), with few related to the technique. The most common complication was cervical anastomotic leak (37%), with a low anastomotic stricture rate (two stenosis: 10.53%). We had one (5.3%) surgical related death, due to a gastric tube`s mediastinal leak, treated by open reoperation and neck diversion. The median Intensive Care Unit stay and hospital stay were two and 12 days, respectively. The mean thoracoscopic stage duration was 77 min. Thirteen patients received neoadjuvant treatment (five squamous cells carcinoma and eight gastroesophageal adenocarcinomas). The average lymph node sample had 16.4 lymph nodes per patient and 22.67 when separately analyzing patients without neoadjuvant treatment. CONCLUSION: the thoraco-laparoscopic approach was a safe technique in the surgical treatment of esophageal cancer, with a good lymph node sampling.

Thoraco-laparoscopic esophagectomy: thoracic stage in prone position / Esofagectomia vídeo-tóraco-laparoscópica com tempo torácico em posição pronada

ABSTRACT Objective: to analyze the National Cancer Institute Abdominopelvic Division (INCA / MS/HC I) initial experience with thoraco-laparoscopic esophagectomy with thoracic stage in prone position. Methods: we studied 19 consecutive thoraco-laparoscopic esophagectomies from may 2012 to august 2014, including ten patients with squamous cells carcinoma (five of the middle third and five of the lower third) and nine cases of gastroesophageal junction adenocarcinoma (six Siewert I and three Siewert II). All procedures were initiated by the prone thoracic stage. Results: There were minimal blood loss, optimal mediastinal visualization, oncological radicality and no conversions. Surgical morbidity was 42 %, most being minor complications (58% Clavien I or II), with few related to the technique. The most common complication was cervical anastomotic leak (37%), with a low anastomotic stricture rate (two stenosis: 10.53%). We had one (5.3%) surgical related death, due to a gastric tube`s mediastinal leak, treated by open reoperation and neck diversion. The median Intensive Care Unit stay and hospital stay were two and 12 days, respectively. The mean thoracoscopic stage duration was 77 min. Thirteen patients received neoadjuvant treatment (five squamous cells carcinoma and eight gastroesophageal adenocarcinomas). The average lymph node sample had 16.4 lymph nodes per patient and 22.67 when separately analyzing patients without neoadjuvant treatment. Conclusion: the thoraco-laparoscopic approach was a safe technique in the surgical treatment of esophageal cancer, with a good lymph node sampling.

RESUMO Objetivo: analisar a experiência inicial do Serviço de Cirurgia Abdomino-Pélvica do Instituto Nacional de Câncer (INCA/MS/HC I) na esofagectomia vídeo-tóraco-laparoscópica com tempo torácico pronado. Métodos: estudo de 19 esofagectomias vídeo-tóraco-laparoscópicas realizadas de maio de 2012 a agosto de 2014, em dez pacientes portadores de carcinoma epidermoide esofágico (cinco do 1/3 médio e cinco do 1/3 inferior) e em nove portadores de adenocarcinoma da cárdia (seis Siewert I e três Siewert II). Todas as cirurgias foram iniciadas pelo tempo torácico em posição pronada, com mínima perda sanguínea, adequada visualização das estruturas mediastinais, radicalidade oncológica e sem conversões. Resultados: a morbidade cirúrgica foi de 42%, sendo a maioria complicações menores (58% Clavien I ou II). A complicação mais comum foi a fístula cervical em sete casos (37%), com baixa incidência de estenose anastomótica (duas estenoses: 10,53%). Houve um óbito (5,3%), relacionado a uma fístula mediastinal do tubo gástrico, tratada com reoperação e exteriorização cervical. As medianas de permanência em Centro de Terapia Intensiva e hospitalar foram respectivamente dois e 12 dias. A mediana do tempo vídeo-toracoscópico foi de 77min. Treze pacientes (68.4%) receberam tratamento neoadjuvante (cinco portadores de carcinomas epidermoides e oito de adenocarcinomas cárdia). A amostragem linfonodal média foi de 16,4 linfonodos por paciente e 22,67 quando analisados isoladamente os casos que não receberam tratamento neoadjuvante. Conclusão: a técnica vídeo-tóraco-laparoscópica se mostrou método seguro no tratamento cirúrgico do câncer do esôfago e proporcionou boa amostragem linfonodal em nossa casuística inicial.

Abordagem vídeo-toracoscópica, sem sutura, das perfurações do esôfago torácico diagnosticadas tardiamente / Video-thoracoscopic approach, without suture, of late thoracic esophageal perforations

RESUMO Objetivos: avaliar a utilização da vídeo-toracoscopia, no tratamento das perfurações tardias do esôfago torácico, sem sutura ou ressecção do órgão. Métodos: análise retrospectiva de pacientes com diagnóstico tardio (>12 horas) de perfuração do esôfago torácico tratados por vídeo-toracoscopia, sem sutura ou ressecção do órgão, num período de 15 anos. Resultados: foram operados 16 pacientes, sendo dez homens e seis mulheres, com idades entre 48 e 66 anos e com tempo entre o diagnóstico da perfuração e a cirurgia variando entre 16 e 26 horas. Todos os pacientes foram submetidos a vídeo-toracoscopia, com decorticação pulmonar, abordagem das loculações pleurais, abertura da pleura mediastinal junto ao local da perfuração e desbridamento dos tecidos desvitalizados, seguido por dupla drenagem da cavidade pleural. Não foi realizada sutura ou ressecção esofagiana, e os pacientes evoluíram com fechamento completo das lesões, sem óbitos. Conclusão: a abordagem cirúrgica vídeo-toracoscópica mostrou-se capaz de controlar a infecção pleural, a expansão pulmonar e possibilitar a completa regeneração do esôfago com perfuração diagnosticada tardiamente.

ABSTRACT Objectives: to evaluate the use of video-thoracoscopy, in the treatment of late perforations of the thoracic esophagus, without suture or organ resection. Methods: retrospective analysis of patients with late diagnosis (> 12 hours) of thoracic esophageal perforation treated by video-thoracoscopy, without suture or organ resection, over a 15-year period. Results: sixteen patients were operated on, ten men and six women, aged between 48 and 66 years, with time between the diagnosis of the perforation and the surgery ranging from 16 to 26 hours. All patients underwent video-thoracoscopy, with pulmonary decortication, pleural loculations approach, opening of the mediastinal pleura near the perforation site and debridement of the devitalized tissues, followed by double drainage of the pleural cavity. No esophageal suture or resection was performed, and the patients evolved with complete closure of the lesions, without deaths. Conclusion: the video-thoracoscopic surgical approach was able to control pleural infection, pulmonary expansion and enable complete regeneration of the esophagus with late-diagnosed perforation.

Avaliação da qualidade de vida de pacientes portadores de hiperidrose primária submetidos à simpatectomia videotoracoscópica / Evaluation of the quality of life of patients with primary hyperhidrosis submitted to videothoracoscopic sympathectomy

RESUMO Objetivo: avaliar a qualidade de vida de pacientes submetidos à simpatectomia por videotoracoscopia para tratamento de hiperidrose primária. Métodos: foram avaliados os pacientes submetidos à simpatectomia por videotoracoscopia para tratamento de hiperidrose primária pela equipe de cirurgia torácica do Hospital Universitário Gafrée e Guinle-UNIRIO entre julho de 2004 e agosto de 2013. Foi aplicado um questionário sobre qualidade de vida relacionada à hiperidrose desde o pré-operatório até um ano após a operação. Resultados: o questionário foi aplicado em 122 pacientes com média de idade de 25 anos, sendo 57% mulheres. Quanto à severidade da hiperidrose primária, 83% dos pacientes referiam como pouco tolerável ou intolerável, associada com grande limitação da qualidade de vida, sendo esta pobre ou muito pobre em 82% dos casos. No pós operatório a hiperidrose compensatória ocorreu em 78% dos pacientes, entretanto foi considerada como imperceptível ou pouco perceptível por 85% destes pacientes, classificando-a como aceitável. Em 15% dos pacientes a hiperidrose compensatória foi classificada como perturbadora. Conclusão: a simpatectomia videotoracoscópica melhora a qualidade de vida dos pacientes com hiperidrose primária. A hiperidrose compensatória transitória ocorreu na maioria dos pacientes, mas não alterou de maneira significativa a melhora da qualidade de vida.

ABSTRACT Objective: to evaluate the quality of life of patients undergoing video-assisted thoracoscopy for primary hyperhidrosis. Methods: we evaluated the patients who underwent thoracoscopic sympathectomy to treat primary hyperhidrosis by the team of thoracic surgery at the University Hospital Gaffrée and Guinle - UNIRIO between July 2004 and August 2013. It was applied a questionnaire about quality of life related to hyperhidrosis since preoperative period until one year after the surgery. Results: one hundred twenty two patients answered the questionnaire, with a mean age of 25 years, 57% of whom were women. In relation to severity of primary hyperhidrosis, 83% of the patients reported as tolerable or somewhat tolerable associated with major limitation of quality of life, which it was poor or very poor in 82% of cases. Postoperative compensatory hyperhidrosis occurred in 78% of patients, but it was regarded as invisible or barely noticeable for 85% of these patients, classifying it as acceptable. In 15% of patients, the compensatory sweating was classified as disruptive. Conclusion: thoracoscopic sympathectomy improves the quality of life of patients with primary hyperhidrosis. The transitional compensatory hyperhidrosis occurred in most patients, but did not improve significantly the quality of life.

Aneurisma volumoso da artéria pulmonar em paciente portador de doença de Behçet: relato de caso / Huge aneurism of the pulmonary artery in patient with Behçet's disease: case report

JUSTIFICATIVA E OBJETIVOS: A doença de Behçet caracteriza-se pela presença de lesões cutâneas, história de ulcerações orais, observação de patergia, envolvimento ocular do tipo uveíte e alterações vasculares. Constitui-se em afecção rara no nosso meio, inscrevendo-se no capítulo das vasculites sistêmicas primárias. RELATO DO CASO: Descrição de manifestação vascular pulmonar incomum, caracterizada pelo desenvolvimento de volumoso aneurisma na circulação arterial pulmonar em paciente com doença de Behçet. CONCLUSÃO: A presença de aneurisma da artéria pulmonar é manifestação rara, porém observada na doença em questão.(AU)

BACKGROUND AND OBJECTIVES: Behçet `s disease is a rare affection characterized by skin lesions, history of aftous ulcers, pathergy, ocular involvement like uveitis, as well as venous and arterial compromise. CASE REPORT: A patient with various systemic manifestations of Behçet’s disease, including a huge aneurysm in the left pulmonary artery. CONCLUSION: The appearance of this unusual vascular alteration is considered a rare manifestation of Behçet’s disease.(AU)

Metástase tumoral de pulmão com invasão cardíaca: relato de um caso e revisão da literatura / Metastatic lung tumor invading the heart: report of one case and review of the literature

Os autores descrevem a evolução clínica de um rapaz de 16 anos com osteossarcoma, primário na perna direita e secundário do pulmão direito com protrusão do tumor para o átrio esquerdo através da veia pulmonar superior direita. O diagnóstico foi realizado durante ecocardiografia como protocolo para detecção de cardiotoxicidade às drogas antineoplásicas. Neste estágio, já havia uma grande metástase pulmonar à direita, irressecável e que foi controlada apenas pela quimioterapia. O paciente desenvolveu sinais clínicos de obstrução do átrio esquerdo e hipertensão arterial pulmonar, sendo submetido a ressecção da protrusão tumoral por cirurgia cardíaca aberta. No entanto, mesmo com prognóstico ruim, sobreviveu por quatro meses mais. A despeito do prognóstico pobre esperado, este tipo de cirurgia não impõe dificuldades técnicas e deveria ser feita sempre que possível tendo em vista a melhora da qualidade de vida que poderá trazer