16 research outputs found
Negative-pressure Pulmonary Edema And Hemorrhage Associated With Upper Airway Obstruction [edema E Hemorragia Pulmonar Por Pressão Negativa Associados à Obstrução Das Vias Aéreas Superiores]
No full textNegative-pressure pulmonary edema accompanied by hemorrhage as a manifestation of upper airway obstruction is an uncommon problem that is potentially life-threatening. The principal pathophysiological mechanism involved is the generation of markedly negative intrathoracic pressure, which leads to an increase in pulmonary vascular volume and pulmonary capillary transmural pressure, creating a risk of disruption of the alveolar-capillary membrane. We report the case of an adult male with diffuse alveolar hemorrhage following acute upper airway obstruction caused by the formation of a cervical and mediastinal abscess resulting from the insertion of a metallic tracheal stent. The patient was treated through drainage of the abscess, antibiotic therapy, and positive pressure mechanical ventilation. This article emphasizes the importance of including this entity in the differential diagnosis of acute lung injury after procedures involving upper airway instrumentation.346420424Koh, M.S., Hsu, A.A., Eng, P., Negative pressure pulmonary oedema in the medical intensive care unit (2003) Intensive Care Med, 29 (9), pp. 1601-1604Bhavani-Shankar, K., Hart, N.S., Mushlin, P.S., Negative pressure induced airway and pulmonary injury (1997) Can J Anaesth, 44 (1), pp. 78-81Schwartz, D.R., Maroo, A., Malhotra, A., Kesselman, H., Negative pressure pulmonary hemorrhage (1999) Chest, 115 (4), pp. 1194-1197Van Kooy, M.A., Gargiulo, R.F., Postobstructive pulmonary edema (2000) Am Fam Physician, 62 (2), pp. 401-404Pavlin, D.J., Nessly, M.L., Cheney, F.W., Increased pulmonary vascular permeability as a cause of re-expansion edema in rabbits (1981) Am Rev Respir Dis, 124 (4), pp. 422-427Willms, D., Shure, D., Pulmonary edema due to upper airway obstruction in adults (1988) Chest, 94 (5), pp. 1090-1092Guffin, T.N., Har-el, G., Sanders, A., Lucente, F.E., Nash, M., Acute postobstructive pulmonary edema (1995) Otolaryngol Head Neck Surg, 112 (2), pp. 235-237McGowan, F.X., Kenna, M.A., Fleming, J.A., O'Connor, T., Adenotonsillectomy for upper airway obstruction carries increased risk in children with a history of prematurity (1992) Pediatr Pulmonol, 13 (4), pp. 222-226Ikeda, H., Asato, R., Chin, K., Kojima, T., Tanaka, S., Omori, K., Negative-pressure pulmonary edema after resection of mediastinum thyroid goiter (2006) Acta Otolaryngol, 126 (8), pp. 886-888West, J.B., Mathieu-Costello, O., Stress failure of pulmonary capillaries: Role in lung and heart disease (1992) Lancet, 340 (8822), pp. 762-767Rocker, G.M., Mackenzie, M.G., Williams, B., Logan, P.M., Noninvasive positive pressure ventilation: Successful outcome in patients with acute lung injury/ARDS (1999) Chest, 115 (1), pp. 173-177Butterell, H., Riley, R.H., Life-threatening pulmonary oedema secondary to tracheal compression (2002) Anaesth Intensive Care, 30 (6), pp. 804-806Antonelli, M., Conti, G., Moro, M.L., Esquinas, A., Gonzalez-Diaz, G., Confalonieri, M., Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: A multi-center study (2001) Intensive Care Med, 27 (11), pp. 1718-1728Adolph, M.D., Oliver, A.M., Dejak, T., Death from adult respiratory distress syndrome and multiorgan failure following acute upper airway obstruction (1994) Ear Nose Throat J, 73 (5), pp. 324-327Westreich, R., Sampson, I., Shaari, C.M., Lawson, W., Negative-pressure pulmonary edema after routine septorhinoplasty: Discussion of pathophysiology, treatment, and prevention (2006) Arch Facial Plast Surg, 8 (1), pp. 8-15Ackland, G.L., Mythen, M.G., Negative pressure pulmonary edema as an unsuspected imitator of acute lung injury/ARDS (2005) Chest, 127 (5), pp. 1867-186
Bronchoscopy For Foreign Body Removal: Where Is The Delay? [broncoscopia Para Remoção De Corpo Estranho: Onde Está O Atraso?]
No full textThis was a retrospective analysis of the medical charts of 145 patients treated at the Bronchoscopy and Thoracic Surgery Clinic of the Hospital das Clínicas da Universidade Estadual de Campinas (HC-Unicamp, State University of Campinas Hospital das Clínicas) over a period of 10 years. There was a significant difference related to the site of first medical visit (Unicamp-HC versus other institutions) in terms of the time elapsed between the suspicion of bronchial aspiration and the actual respiratory endoscopic examination. However, no significant difference was found in the rate of positive results. The low number of referral centers that provide emergency respiratory endoscopy can negatively influence the treatment of patients under suspicion of bronchial aspiration, jeopardizing the overall recovery in the mid- and long-term.3411956958Zerella, J.T., Dimler, M., McGill, L.C., Pippus, K.J., Foreign body aspiration in children: Value of radiography and complications of bronchoscopy (1998) J Ped Surg, 33 (11), pp. 1651-1654Fraga, A.M., Reis, M.C., Zambon, M.P., Toro, I.C., Ribeiro, J.D., Baracat, E.C., Foreign body aspiration in children: Clinical aspects, radiological aspects and bronchoscopic treatment (2008) J Bras Pneumol, 34 (2), pp. 74-82Swanson, K.L., Prakash, U.B., Midthun, D.E., Edell, E.S., Utz, J.P., McDougall, J.C., Flexible bronchoscopic management of airway foreign bodies in children (2002) Chest, 121 (5), pp. 1695-1700Pritt, B., Harmon, M., Schwartz, M., Cooper, K., A tale of three aspirations: Foreign bodies in the airway (2003) J Clin Pathol, 56 (10), pp. 791-794Cataneo, A.J., Reibscheid, S.M., Ruiz Júnior, R.L., Ferrari, G.F., Foreign body in the tracheobronchial tree (1997) Clin Pediatr (Phila), 36 (12), pp. 701-706Applegate, K.E., Dardinger, J.T., Lieber, M.L., Herts, B.R., Davros, W.J., Obuchowski, N.A., Spiral CT scanning technique in the detection of aspiration of LEGO foreign bodies (2001) Pediatr Radiol, 31 (12), pp. 836-840Lima, J.A., Fischer, G.B., Felicetti, J.C., Flores, J.A., Penna, C.N., Ludwig, E., Aspiração de corpo estranho na árvore traqueobrônquica em crianças: Avaliação de seqüelas através de exame cintilográfico. (2000) J Pneumol, 26 (1), pp. 20-24Cassol, V., Pereira, A.M., Zorzela, L.M., Becker, M.M., Barreto, S.S., Corpo estranho na via aérea de crianças. (2003) J Pneumol, 29 (3), pp. 139-144Fraga, J.C., Nogueira, A., Palombini, B.C., Corpo estranho em via aérea de criança. (1994) J Pneumol, 20 (3), pp. 107-111Piva, J., Giugno, K., Maia, T., Mascarenhas, T., Nogueira, A., Kalil, L., Aspiração de corpo estranho: Revisão de 19 casos. (1989) J Pediat, 65 (10), pp. 399-403Inglis Jr, A.F., Wagner, D.V., Lower complication rates associated with bronchial foreign bodies over the last 20 years (1992) Ann Otol Rhinol Laryngol, 101 (1), pp. 61-66Davies, H., Gordon, I., Matthew, D.J., Helms, P., Kenney, I.J., Lutkin, J.E., Long term follow up after inhalation of foreign bodies (1990) Arch Dis Child, 65 (6), pp. 619-621Black, R.E., Choi, K.J., Syme, W.C., Johnson, D.G., Matlak, M.E., Bronchoscopic removal of aspirated foreign bodies in children (1984) Am J Surg, 148 (6), pp. 778-78
Postintubation Injuries And Open Surgical Tracheostomy: Should We Always Perform Isthmectomy? [sequelas Pós-intubação E Traqueostomia Cirúrgica Aberta: Devemos Sempre Fazer A Istmectomia?]
No full textObjective: To evaluate the influence of the surgical team (general surgery or thoracic surgery) and the surgical technique (with or without isthmectomy) on the incidence of postintubation injuries in the airways of tracheostomized patients. Methods: Between January 1st and August 31st, 2007, 164 patients admitted to the adult intensive care unit and tracheally intubated for more than 24 h were studied prospectively at the Sumaré State Hospital, located in the city of Sumaré, Brazil. When tracheostomy was necessary, these patients were randomly assigned to thoracic or general surgery teams. All of the patients were submitted to fiberoptic tracheoscopy for decannulation or late evaluation of the airway. Results: Of the 164 patients in the study, 90 (54.88%) died (due to causes unrelated to the procedure), 67 (40.85%) completed follow-up, and 7 (4.27%) were lost to follow-up. Of the 67 patients who completed follow-up, 32 had undergone tracheostomy (21 by the general surgery team and 11 by the thoracic surgery team), and 22 had been submitted to isthmectomy (11 by the general surgery team and 11 by the thoracic surgery team). There was no difference between the surgical teams in terms of the incidence of stoma complications. However, there was a significant difference when the surgical techniques (with or without isthmectomy) were compared. Conclusions: Not performing isthmectomy in parallel with tracheostomy leads the surgeon to open the tracheal stoma more distally than expected. In such cases, there were more stoma complications.353227233Maddaus, M.A., Pearson, F.G., Postintubation injury (2002) Pearson's Thoracic and Esophageal Surgery, pp. 300-314. , In: Pearson FG, Patterson GA, editors, Philadelphia: Churchill Livingstone/ElsevierStreitz Jr, J.M., Shapshay, S.M., Airway injury after tracheotomy and endotracheal intubation (1991) Surg Clin North Am, 71 (6), pp. 1211-30Park, M., Brauer, L., Sanga, R.R., Kajdacsy-Balla, A.C., Ladeira, J.P., Azevedo, L.C., Percutaneous Tracheostomy in Critically-ill Patients: The Experience of a Medical Intensive Care Unit (2004) J Bras Pneumol., 30 (3), pp. 237-242Ciaglia, P., Firsching, R., Syniec, C., Elective percutaneous dilatational tracheostomy. A new simple bedside procedurepreliminary report (1985) Chest, 87 (6), pp. 715-9Epstein, S.K., Late complications of tracheostomy (2005) Respir Care, 50 (4), pp. 542-9Pearson, F.G., Goldberg, M., da Silva, A.J., A prospective study of tracheal injury complicating tracheostomy with a cuffed tube (1968) Ann Otol Rhinol Laryngol, 77 (5), pp. 867-82Braz, J.R., Navarro, L.H., Takata, I.H., Nascimento Júnior, P., Endotracheal tube cuff pressure: Need for precise measurement (1999) Sao Paulo Med J, 117 (6), pp. 243-7Goldstraw, P., Morgam, C., Tracheostomy (2002) Pearson's Thoracic and Esophageal Surgery, pp. 375-383. , In: Pearson FG, Patterson GA, editors, Philadelphia: Churchill Livingstone/ ElsevierPutnam Jr., J.B., Traquéia (2005) Sabiston Tratado De Cirurgia, pp. 1792-1793. , In: Townsend MC, editor, Rio de Janeiro: ElsevierVianna, A., Tracheostomy in patients on mechanical ventilation: When is it indicated? (2007) J Bras Pneumol., 33 (6), pp. xxxvii-xxxviiiPerfeiro, J.A., Mata, C.A., Forte, V., Carnaghi, M., Tamura, N., Leão, L.E., Tracheostomy in the ICU: Is it worthwhile? (2007) J Bras Pneumol., 33 (6), pp. 687-90Leite, A.G., Kussler, D., Management of recurrent distal tracheal stenosis using an endoprosthesis: A case report (2008) J Bras Pneumol., 34 (2), pp. 121-5Arabi, Y., Haddad, S., Shirawi, N., Al Shimemeri, A., Early tracheostomy in intensive care trauma patients improves resource utilization: A cohort study and literature review (2004) Crit Care, 8 (5), pp. R347-52Croshaw, R., McIntyre, B., Fann, S., Nottingham, J., Bynoe, R., Tracheostomy: Timing revisited (2004) Curr Surg, 61 (1), pp. 42-8Walts, P.A., Murthy, S.C., Arroliga, A.C., Yared, J.P., Rajeswaran, J., Rice, T.W., Tracheostomy after cardiovascular surgery: An assessment of long-term outcome (2006) J Thorac Cardiovasc Surg, 131 (4), pp. 830-7Plummer, A.L., Gracey, D.R., Consensus conference on artificial airways in patients receiving mechanical ventilation (1989) Chest, 96 (1), pp. 178-80Leung, R., Macgregor, L., Campbell, D., Berkowitz, R.G., Decannulation and survival following tracheostomy in an intensive care unit (2003) Ann Otol Rhinol Laryngol., 112 (10), pp. 853-8Pinet, C., Quenee, V., Sainty, J.M., Significance of systematic endoscopic decannulation. Retrospective study on intensive care patients [Article in French] (1998) Rev Pneumol Clin., 54 (2), pp. 81-4Nouraei, S.A., Singh, A., Patel, A., Ferguson, C., Howard, D.J., Sandhu, G.S., Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis (2006) Laryngoscope., 116 (8), pp. 1417-21Coelho, M.S., Zampier, J.A., Zanin, S.A., Silva, E.M., Guimarães, P.S., Fístula traqueoesofágica como complicação tardia de traqueostomia (2001) J Pneumol., 27 (2), pp. 119-22Grillo, H.C., Mathisen, D.J., Wain, J.C., Laryngotracheal resection and reconstruction for subglottic stenosis (1992) Ann Thorac Surg., 53 (1), pp. 54-63Saueressig, M.G., Macedo-Neto, A.V., Moreschi, A.H., Xavier, R.G., Sanches, P.R., A correção das estenoses traqueobrônquicas mediante o emprego de órteses (2002) J Pneumol., 28 (2), pp. 84-93Terra, R.M., Minamoto, H., Tedde, M.L., Almeida, J.L., Jatene, F.B., Self-expanding stent made of polyester mesh with silicon coating (Polyflex®) in the treatment of inoperable tracheal stenoses (2007) J Bras Pneumol., 33 (3), pp. 241-7Gravvanis, A.I., Tsoutsos, D.A., Iconomou, T.G., Papadopoulos, S.G., Percutaneous versus Conventional Tracheostomy in Burned Patients with Inhalation Injury (2005) World J Surg., 29 (12), pp. 1571-5Karagiannidis, C., Velehorschi, V., Obertrifter, B., Macha, H.N., Linder, A., Freitag, L., High-level expression of matrix-associated transforming growth factor-beta1 in benign airway stenosis (2006) Chest., 129 (5), pp. 1298-30
Use Of A One-way Flutter Valve Drainage System In The Postoperative Period Following Lung Resection [utilização Da Válvula Unidirecional De Tórax Como Sistema De Drenagem No Pós-operatório De Ressecç ões Pulmonares]
No full textObjective: To evaluate pleural drainage using a one-way flutter valve following elective lung resection. Methods: This was a prospective study, with descriptive analysis, of 39 lung resections performed using a one-way flutter valve to achieve pleural drainage during the postoperative period. Patients less than 12 years of age were excluded, as were those submitted to pneumonectomy or emergency surgery, those who were considered lost to follow-up and those in whom water-seal drainage was used as the initial method of pleural drainage. Lung expansion, duration of the drainage, hospital stay and postoperative complications were noted. Results: A total of 36 patients were included and analyzed in this study. The mean duration of pleural drainage was 3.0 ± 1.6 days. At 30 days after the surgical procedure, chest X-ray results were considered normal for 34 patients (95.2%). Postoperative complications occurred in 8 patients (22.4%) and were related to the drainage system in 3 (8.4%) of those. Conclusions: The use of a one-way flutter valve following elective lung resection was effective, was well tolerated and presented a low rate of complications.348559566Kenyon, J.H., Traumatic Hemothorax: Siphon drainage (1916) Ann Surg, 64, pp. 728-729Lilienthal, H., Resection of the lung for suppurative infections with a report based on 31 operative cases in which resection was done or intended (1922) Ann Surg, 75 (3), pp. 257-320Heimlich, H.J., Valve drainage of the pleural cavity (1968) Dis Chest, 53 (3), pp. 282-287Waller, D.A., Edwards, J.G., Rajesh, P.B., A physiological comparison of flutter valve drainage bags and underwater seal systems for postoperative air leaks (1999) Thorax, 54 (5), pp. 442-443Lima, A.G., Rocha, E.R., Santos, N.A., Seabra, J.C., Mussi, R.K., Santos, J.G., Avalia̧ão do uso da bra̧adeira ou "clamp" na drenagem pleural fechada subaquática. Estudo prospectivo aleatorizado. (2007) J Bras Pneumol, 33 (SUPL 1R), pp. R13Vuorisalo, S., Aarnio, P., Hannukainen, J., Comparison between flutter valve drainage bag and underwater seal device for pleural drainage after lung surgery (2005) Scand J Surg, 94 (1), pp. 56-58Graham, A.N., Cosgrove, A.P., Gibbons, J.R., McGuigan, J.A., Randomised clinical trial of chest drainage systems (1992) Thorax, 47 (6), pp. 461-462Bar-El, Y., Lieberman, Y., Yellin, A., Modified urinary collecting bags for prolonged underwater chest drainage (1992) Ann Thorac Surg, 54 (5), pp. 995-996Ortega, H.A.V., Lima, M.P., Denadai, J.O., Válvula unidirecional aplicada ao tratamento ambulatorial do pneumotórax. (1996) J Pneumol, 22 (4), pp. 177-180Figueiredo Pinto, J.A., Leite, A.G., Cavalet, D., Drenagem torácica: Princípios básicos (2001) Manual de cirurgia torácica, pp. 109-125. , Pinto Filho DR, Cardoso PF, Figueiredo Pinto JA, Scheineider A, editors, Rio de Janeiro: Revinter;Gŕgoire, J., Deslauries, J., Closed drainage and suction systems (2002) Thoracic Surgery, pp. 1281-1297. , Pearson FG, Deslauries J, Ginsberg RJ, Hiebert CA, Mckneally MF, Urschel HC, editors, New York: Churchill Livingstone;Marshall, M.B., Deeb, M.E., Bleier, J.I., Kucharczuk, J.C., Friedberg, J.S., Kaiser, L.R., Suction vs water seal after pulmonary resection: A randomized prospective study (2002) Chest, 121 (3), pp. 831-835McKenna Jr, R.J., Fischel, R.J., Brenner, M., Gelb, A.F., Use of the Heimlich valve to shorten hospital stay after lung reduction surgery for emphysema (1996) Ann Thorac Surg, 61 (4), pp. 1115-1117Okamoto, J., Okamoto, T., Fukuyama, Y., Ushijima, C., Yamaguchi, M., Ichinose, Y., The use of a water seal to manage air leaks after a pulmonary lobectomy: A retrospective study (2006) Ann Thorac Cardiovasc Surg, 12 (4), pp. 242-244Cerfolio, R.J., Bass, C., Katholi, C.R., Prospective randomized trial compares suction versus water seal for air leaks (2001) Ann Thorac Surg, 71 (5), pp. 1613-1617Antanavicius, G., Lamb, J., Papasavas, P., Caushaj, P., Initial chest tube management after pulmonary resection (2005) Am Surg, 71 (5), pp. 416-419Lima, A.G., Contrera Toro, I.F., Tincani, A.J., Barreto, G., A drenagem pleural pré-hospitalar: Apresentação de mecanismo de válvula unidirecional. (2006) Rev Col Bras Cir, 33 (2), pp. 101-106Ponn, R.B., Silverman, H.J., Federico, J.A., Outpatient chest tube management (1997) Ann Thorac Surg, 64 (5), pp. 1437-1440Campisi, P., Voitk, A.J., Outpatient treatment of spontaneous pneumothorax in a community hospital using a Heimlich flutter valve: A case series (1997) J Emerg Med, 15 (1), pp. 115-119Williams, J.G., Riley, T.R., Moody, R.A., Resuscitation experience in the Falkland Islands campaign (1983) Br Med J (Clin Res Ed), 286 (6367), pp. 775-777Schweitzer, E.J., Hauer, J.M., Swan, K.G., Bresch, J.R., Harmon, J.W., Graeber, G.M., Use of the Heimlich valve in a compact autotransfusion device (1987) J Trauma, 27 (5), pp. 537-542Beyruti, R., Villiger, L.E., Campos, J.R., Silva, R.A., Fernandez, A., Jatene, F.B., A válvula de Heimlich no tratamento do pneumotórax. (2002) J Pneumol, 28 (3), pp. 115-119Mainini, S.E., Johnson, F.E., Tension pneumothorax complicating small-caliber chest tube insertion (1990) Chest, 97 (3), pp. 759-760Lodi, R., Stefani, A., A new portable chest drainage device (2000) Ann Thorac Surg, 69 (4), pp. 998-1001Sanches, P.G., Vendrame, G.S., Madke, G.R., Pilla, E.S., Camargo, J.J., Andrade, C.F., (2006) Lobectomy for treating bronchial carcinoma: Analysis of comorbidities and their impact on postoperative morbidity and mortality J Bras Pneumol, 32 (6), pp. 495-504Lang-Lazdunski, L., Chapuis, O., Bonnet, P.M., Pons, F., Jancovici, R., Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: Long-term results (2003) Ann Thorac Surg, 75 (3), pp. 960-965Russo, L., Wiechmann, R.J., Magovern, J.A., Szydlowski, G.W., Mack, M.J., Naunheim, K.S., Early chest tube removal after video-assisted thoracoscopic wedge resection of the lung (1998) Ann Thorac Surg, 66 (5), pp. 1751-1754Watanabe, A., Watanabe, T., Ohsawa, H., Mawatari, T., Ichimiya, Y., Takahashi, N., Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung (2004) Eur J Cardiothorac Surg, 25 (5), pp. 872-876Molins, L., Fibla, J.J., Ṕrez, J., Sierra, A., Vidal, G., Siḿn, C., Outpatient thoracic surgical programme in 300 patients: Clinical results and economic impact (2006) Eur J Cardiothorac Surg, 29 (3), pp. 271-275Tang, A.T., Velissaris, T.J., Weeden, D.F., An evidence-based approach to drainage of the pleural cavity: Evaluation of best practice (2002) J Eval Clin Pract, 8 (3), pp. 333-34
Standardization Of A Method Of Prolonged Thoracic Surgery And Mechanical Ventilation In Rats To Evaluate Local And Systemic Inflammation
No full textPurpose: To evaluate the immediate pulmonary and systemic inflammatory response after a long-term operative period. Methods: Wistar rats in the experimental group were anaesthetized and submitted to tracheostomy, thoracotomy and remained on mechanical ventilation during three hours. Control animals were not submitted to the operative protocol. The following parameters have been evaluated: pulmonary myeloperoxidase activity, pulmonary serum protein extravasation, lung wet/dry weight ratio and measurement of levels of cytokines in serum. Results: Operated animals exhibited significantly lower serum protein extravasation in lungs compared with control animals. The lung wet/dry weight ratio and myeloperoxidase activity did not differ between groups. Serum cytokines IL-1β, TNF-α, and IL-10 levels were not detected in groups, whereas IL-6 was detected only in operated animals. Conclusion: The experimental mechanical ventilation in rats with a prolonged surgical time did not produce significant local and systemic inflammatory changes and permit to evaluate others procedures in thoracic surgery.2613843Gothard, J., Lung injury after thoracic and one-lung ventilation (2006) Curr Opin Anaesthesiol, 19 (1), pp. 5-10Matute-Bello, G., Frevert, C.W., Martin, T.R., Animal models of acute lung injury (2008) Am J Physiol Cell Mol Physiol, 295 (3), pp. L379-99Braeuninger, S., Kleinschnitz, C., Rodent models of focal ischemia: Procedural pitfalls and translational problems (2009) Exp Transl Stroke Med, 25, pp. 1-8Brain, S.D., Williams, T.J., Inflammatory oedema induced by synergism between calcitonin gene-related peptide (CGRP) and mediators of increased vascular permeability (1985) Br J Pharmacol, 86, pp. 855-860Bradley, P.P., Priebat, D.A., Christensen, R.D., Rothstein, G., Measurement of cutaneous inflammation: Estimation of neutrophil content with an enzyme marker (1982) J Invest Dermatol, 78 (3), pp. 206-209Chang, K.P., Huang, S.H., Lin, C.L., Chang, L.L., Lin, S.D., Lai, C.S., An alternative model of composite tissue allotransplantation: Groin-thigh flap (2008) Transpl Int, 21 (6), pp. 564-571Unzueta, M.C., Casas, J.I., Moral, M.V., Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery (2007) Anesth Analg, 104 (5), pp. 1029-1033Tanaka, S., Tsuchida, H., Nakabayashi, K.-I., Seki, S., Namiki, A., The effects of sevoflurane, isoflurane, halothane, and enflurane on hemodynamic responses during an inhaled induction of anesthesia via a mask in humans (1996) Anesthesia and Analgesia, 82 (4), pp. 821-826. , DOI 10.1097/00000539-199604000-00025Liu, R., Ishibe, Y., Ueda, M., Isoflurane-sevoflurane administration before ischemia attenuates ischemia-reperfusion-induced injury in isolated rat lungs (2000) Anesthesiology, 92 (3), pp. 833-840Lima, R.C., Escobar, M.A.S., Diniz, R., D'Aconda, G., Bergsland, J., Salermo, T., Avaliação hemodinâmica intra-operatória na cirurgia de revascularização do miocárdio sem o auxílio de circulação extracorpórea (2000) Rev Bras Circ Cardiovasc, 15 (3), pp. 201-211Basagan-Mogol, E., Goren, S., Korfali, G., Turker, G., Kaya, F.N., Induction of anesthesia in coronary artery bypass graft surgery: The hemodynamic and analgesic effects of ketamine (2010) Clinics, 65 (2), pp. 133-138Fuentes, J.M., Hanly, E.J., Bachman, S.L., Aurora, A.R., Marohn, M.R., Talamini, M.A., Videoendoscopic endotracheal intubation in the rat: A comprehensive rodent model of laparoscopic surgery (2004) J Surg Res, 122 (2), pp. 240-248Lawrence, T., Wlloughby, D.A., Gilroy, D.W., Anti-inflammatory lipid mediators and insights into the resolution of inflammation (2002) Nat Rev Immunol, 2 (10), pp. 787-795Lewis, C.A., Martin, G.S., Understanding and managing fluid balance in patients with acute lung injury (2004) Curr Opin Crit Care, 10 (1), pp. 13-17Soni, N., Willians, P., Positive pressure ventilation: What is the real cost? 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Continuous Positive Airway Pressure (cpap) After Lung Resection: A Randomized Clinical Trial [pressão Positiva Contínua Nas Vias Aéreas (cpap) Após Ressecção Pulmonar: Ensaio Clínico Randomizado]
No full textCONTEXT AND OBJECTIVE: Noninvasive mechanical ventilation during the postoperative period (PO) following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP) associated with physiotherapy, compared with physiotherapy alone after lung resection. DESIGN AND SETTING: Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas. METHOD: Sessions were held in the immediate postoperative period (POi) and on the first and second postoperative days (PO1 and PO2), and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI), Borg scale, pain scale and presence of thoracic drains and air losses were evaluated. RESULTS: There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP) group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042), than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028), but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001), but there were no statistically significant differences between the groups regarding the pain score. CONCLUSION: CPAP after lung resection is safe and improves oxygenation, without increasing the air losses through the drains.13214147Lumbierres, M., Prats, E., Farrero, E., Noninvasive positive pressure ventilation prevents postoperative pulmonary complications in chronic ventilators users (2007) Respir Med., 101 (1), pp. 62-68Bellinetti, L.M., Thomson, J.C., Respiratory muscle evaluation in elective thoracotomies and laparotomies of the upper abdomen (2006) J Bras Pneumol., 32 (2), pp. 99-105Perrin, C., Jullien, V., Vénissac, N., Prophylactic use of noninvasive ventilation in patients undergoing lung resectional surgery (2007) Respir Med., 101 (7), pp. 1572-1578Benditt, J.O., Novel uses of noninvasive ventilation (2009) Respir Care, 54 (2), pp. 212-219. , discussion 219-22Battisti, A., Michotte, J.B., Tassaux, D., van Gessel, E., Jolliet, P., Non-invasive ventilation in the recovery room for postoperative respiratory failure: A feasibility study (2005) Swiss Med Wkly., 135 (23-24), pp. 339-343Auriant, I., Jallot, A., Hervé, P., Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection (2001) Am J Respir Crit Care Med., 164 (7), pp. 1231-1235Aguiló, R., Togores, B., Pons, S., Noninvasive ventilatory support after lung resectional surgery (1997) Chest., 112 (1), pp. 117-121Oken, M.M., Creech, R.H., Tormey, D.C., Toxicity and response criteria of the Eastern Cooperative Oncology Group (1982) Am J Clin Oncol., 5 (6), pp. 649-655Scanlan, C.L., Myslinski, M.J., Terapia de higiene brônquica (2000) Fundamentos da terapia respiratória de Egan, pp. 817-843. , In: Scanlan CL, Wilkins RL, Stoller JK, editors. 7a ed. São Paulo: ManoleGastaldi, A.C., Magalhães, C.M.B., Baraúna, M.A., Silva, E.M.C., Souza, H.C.D., Benefits of postoperative respiratory kinesiotherapy following laparoscopic cholecystectomy (2008) Rev Bras Fisioter., 12 (2), pp. 100-106Celli, B.R., Chronic respiratory failure after lung resection: The role of pulmonary rehabilitation (2004) Thorac Surg Clin., 14 (3), pp. 417-428Silva, L.C.C., Teste de função pulmonar (2001) Condutas em pneumologia, p. 16. , In: Silva LCC, Rubin AS, Silva LMC, editores. São Paulo: RevinterJaber, S., Michelet, P., Chanques, G., Role of non-invasive ventilation (NIV) in the perioperative period (2010) Best Pract Res Clin Anaesthesiol., 24 (2), pp. 253-265Lefebvre, A., Lorut, C., Alifano, M., Noninvasive ventilation for acute respiratory failure after lung resection: An observational study (2009) Intensive Care Med., 35 (4), pp. 663-670Kindgen-Milles, D., Müller, E., Buhl, R., Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery (2005) Chest., 128 (2), pp. 821-828Kallet, R.H., Diaz, J.V., The physiologic effects of noninvasive ventilation (2009) Respir Care., 54 (1), pp. 102-115Ferreira, H.C., Zin, W.A., Rocco, P.R.M., Physiopathology and clinical management of one-lung ventilation (2004) J Bras Pneumol., 30 (6), pp. 566-573Foroulis, C.N., Kotoulas, C., Konstantinou, M., Lioulias, A., Is the reduction of forced expiratory lung volumes proportional to the lung parenchyma resection, 6 months after pneumonectomy? (2002) Eur J Cardiothorac Surg., 21 (5), pp. 901-905Brunelli, A., Cassivi, S.D., Halgren, L., Risk factors for prolonged air leak after pulmonary resection (2010) Thorac Surg Clin., 20 (3), pp. 359-364Cavicchia, M.G., Soares, S.M.T.P., Dragosavac, D., Araújo, S., Ventilação mecânica em pacientes com fístula broncopleural relato de dois casos (2002) Rev Bras Ter Intensiva., 14 (2), pp. 55-58Stolz, A.J., Schützner, J., Lischke, R., Simonek, J., Pafko, P., Predictors of prolonged air leak following pulmonary lobectomy (2005) Eur J Cardiothorac Surg., 27 (2), pp. 334-336Bardell, T., Legare, J.F., Buth, K.J., Hirsch, G.M., Ali, I.S., ICU readmission after cardiac surgery (2003) Eur J Cardiothoracic Surg., 23 (3), pp. 354-359Lima, V.P., Bonfim, D., Risso, T.T., Influence of pleural drainage on postoperative pain, vital capacity and sixminute walk test after pulmonary resection (2008) J Bras Pneumol., 34 (12), pp. 1003-1007Ambrosino, N., Gabbrielli, L., Physiotherapy in the perioperative period (2010) Best Pract Res Clin Anaesthesiol., 24 (2), pp. 283-289Agostini, P., Singh, S., Incentive spirometry following thoracic surgery: What should we be doing? (2009) Physiotherapy., 95 (2), pp. 76-82Overend, T.J., Anderson, C.M., Lucy, S.D., The effect of incentive spirometry on postoperative pulmonary complications: A systematic review (2001) Chest., 120 (3), pp. 971-97
The use of SPECT in preoperative assessment of patients with lung cancer
No full textPerfusion scintigraphy is the most frequently used method for the regional assessment of pulmonary function in candidates for pulmonary resection with borderline respiratory function. This method provides two-dimensional images, and it considers all the segments of the pulmonary lobes as having the same volume and function, without considering the spatial overlapping of pulmonary areas with different function. As single-photon emission computed tomography (SPECT) provides tomographic imaging, this could be a more precise method for regional assessment. In this study, the postoperative predicted forced expiratory volume in one second (FEV1) (FEV1,ppo) was calculated in 26 patients with lung cancer using FEV1, quantitative lung perfusion scan with planar acquisition (PA) and quantitative lung perfusion scan with tomographic imaging (SPECT). The estimated FEV1,ppo values obtained using both methods were compared with FEV1 values measured after surgery (mean: 484+/-4 days; range: 15-180 days; median: 32 days). The Pearson's linear correlation coefficient was 0.8840 for FEV1,ppo estimated by PA and 0.8791 for FEV1,ppo estimated by SPECT. The linear correlation coefficient for lobectomy was greater than the coefficient for pneumonectomy using both methods. In conclusion, both methods show good correlation for real postoperative pulmonary function without demonstrating single-photon emission computed tomography superiority over planar acquisition, and both methods were more effective for estimating postoperative predicted forced expiratory volume in one second in lobectomies than in pneumonectomies24225826
Prognostic Factors For Complications Following Pulmonary Resection: Pre-albumin Analysis, Time On Mechanical Ventilation, And Other Factors [fatores Prognósticos Em Complicações Pós-operatórias De Ressecção Pulmonar: Análise De Pré-albumina, Tempo De Ventilação Mecânica E Outros]
No full textObjective: To determine whether pre-operative nutritional status and post-operative time on mechanical ventilation, as well as others factors, are correlated with post-operative complications (general or pulmonary) in patients undergoing elective thoracic surgery. Methods: A prospective study was conducted, involving 71 patients undergoing elective pulmonary resection. The data collected pre-operatively included gender, age, smoking status, pre-albumin level, lymphocyte count, and body mass index. The peri-operative data included type of surgery and surgical time, as well as post-operative time on mechanical ventilation. Results: Post-operative complications were found to correlate with low pre-albumin concentration, type of resection, surgical time, and post-operative time on mechanical ventilation. Surgical time and post-operative time on mechanical ventilation were also implicated in the post-operative pulmonary complications observed in 22 (30.99%) of the patients studied. Conclusion: Our results suggest that pre-albumin concentration, type of surgery and surgical time, as well as post-operative time on mechanical ventilation, serve as predictive indices of post-operative complications in patients undergoing elective pulmonary resection. In the analysis of the post-operative pulmonary complications, statistically significant correlations were found between such complications and increases in surgical time or post-operative time on mechanical ventilation.326489494Mirra AP, Justo FA. Particularidades da cirurgia pulmonar. In: Jorge Filho I, Andrade JI de, Ziliotto Junior A, editores. Cirurgia geral: pré e pós-operatório. São Paulo: Atheneu1995. p.605Jackson CV. Preoperative pulmonary evaluation. Arch Intern Med. 1988;148(10):2120-7. Comment in: Arch Intern Med. 1990;150(5):1116Trayner Jr, E., Celli, B.R., Postoperative pulmonary complications (2001) Med Clin North Am, 85 (5), pp. 1129-1139Jorge Filho I, Basile Filho A, Madureira Filho D. Avaliação nutricional. In: Jorge Filho I, Andrade JI de, Ziliotto Junior A, editores. Cirurgia geral: pré e pósoperatório. São Paulo: Atheneu1995. p.28-9Bryant, L.R., Morgan Junior, C.V., Parede torácica, pleura, pulmão e mediastino (1985) Princípios de cirurgia, pp. 685-689. , Schwartz SI, editor, 4a ed. Rio de Janeiro: Guanabara KooganHalbertsma, F.J., Vaneker, M., Scheffer, G.J., van der Hoeven, J.G., Cytokines and biotrauma in ventilator-induced lung injury: A critical review of the literature (2005) Neth J Med, 63 (10), pp. 382-392Pierson, D.J., Branson, R.D., (1992) Professor's rounds in respiratory care: Prevention of postoperative atelectasis and pneumonia [videoconference], , Irving, Texas: American Association for Respiratory CareNovember 17O'Donohue Jr., W.J., Postoperative pulmonary complications. When are preventive and therapeutic measures necessary? (1992) Postgrad Med, 91 (3), pp. 167-170,173-175Peper, E.A., Conrad, S.A., Respiratory complications of surgery and thoracic trauma (1990) Chest medicine: Essentials of pulmonary and critical care medicine, pp. 453-473. , George R, Light R, Matthay M, Matthay R, editors, Baltimore: Williams & Wilkins;Pesola, G., Nashaa, E., Kvetan, V., Pulmonary complications and respiratory therapy (1990) Postanesthetic care, pp. 63-79. , Frost E, Goldiner P, Bryan-Brown C, editors, Norwalk, Connecticut: Appleton Lange;Schulak, J.A., Complicações cirúrgicas (1996) Fundamentos de cirurgia, pp. 116-118. , Sabiston Junior DC, Lyerly HK, editores, 2a ed. Rio de Janeiro, Guanabara Koogan;Fonseca, J.S., Martins, G.A., (1994) Curso de estatística, , 5a ed. São Paulo: AtlasHosmer, D.L., Lemeshow, S., (1989) Applied logistic regression, , New York: John Wiley Sons;Boring, C.C., Squires, T.S., Tong, T., Montgomery, S., Cancer statistics, 1994 (1994) CA Cancer J Clin, 44 (1), pp. 7-26Wang, J., Ultman, R., Olak, J., Prospective trial of diffusing capacity and oxygen consumption in the prediction of pulmonary complications after lung resection (1997) Chest, 112, pp. 153SGaribaldi, R.A., Britt, M.R., Coleman, M.L., Reading, J.C., Pace, N.L., (1981) Risk factors for postoperative pneumonia. Am J Med, 70 (3), pp. 677-680Bolliger, C.T., Perruchoud, A.P., Functional evaluation of the lung resection candidate (1998) Eur Respir J, 11 (1), pp. 198-212Berggren, H., Ekroth, R., Malmberg, R., Naucler, J., William-Olsson, G., Hospital mortality and long-term survival in relation to preoperative function in elderly patients with bronchogenic carcinoma (1984) Ann Thorac Surg, 38 (6), pp. 633-636Damhuis, R.A., Schutte, P.R., Resection rates and postoperative mortality in 7,899 patients with lung cancer (1996) Eur Respir J, 9 (1), pp. 7-10Nakagawa M, Tanaka H, Tsukuma H, Kishi Y. Relationship between the duration of the preoperative smoke-free period and the incidence of postoperative pulmonary complications after pulmonary surgery. Chest. 2001;120(3): 705-10. Comment in: Chest. 2005;127(6):1873-5Junqueira JC dos S. Fatores de risco nutricionais nas complicações pós-operatórias em pacientes idosos submetidos à cirurgia eletiva de grande porte.[tese]. Campinas: Universidade Estadual de Campinas. 2002Sullivan DH. What do the serum proteins tell us about our elderly patients? J Gerontol A Biol Sci Med Sci. 2001;56(2):M71-4. Comment on: J Gerontol A Biol Sci Med Sci. 2001;56(2):M79-82Measurement of visceral protein status in assessing protein and energy malnutrition: Standard of care. Prealbumin in Nutritional Care Consensus Group (1995) Nutrition, 11 (2), pp. 169-171Doyle, R.L., Assessing and modifying the risk of postoperative pulmonary complications (1999) Chest, 115 (5 SUPPL.), pp. 77S-81SPierson, D.J., Complications associated with mechanical ventilation (1990) Crit Care Clin, 6 (3), pp. 711-724Mayo-Moldes M, Villalain-Perez C, Vicente-Guillen R, Ramos-Briones F, Calvo-Medina V, Morales-Marin P, e t al . [Lung transpl ant at ion for emphy s ema: retrospective study of 65 patients] Med Clin (Barc). 2005;125(16):618-21. Spanish. Comment in: Med Clin (Barc). 2005;125(16):616-7Jiang, S.P., Li, Z.Y., Huang, L.W., Zeng, Z.Y., Chang, J.X., Chen, S., Risk factors for postoperative pulmonary complications after gastroduodenal operation] (2005) Zhonghua Wei Chang Wai Ke Za Zhi, 8 (5), pp. 425-428. , Chines
Descriptive Analysis Of And Overall Survival After Surgical Treatment Of Lung Metastases [análise Descritiva E Sobrevida Global Do Tratamento Cirúrgico Das Metástases Pulmonares]
No full textObjective: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. Methods: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. Results: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). Conclusions: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases.396650658Aberg, T., Malmberg, K.A., Nilsson, B., Nöu, E., The effect of metastasectomy: Fact or fiction? (1980) Ann Thorac Surg., 30 (4), pp. 378-384. , http://dx.doi.org/10.1016/S0003-4975(10)61278-7Weinlechner, J.D., Tumorenan der brustwand und derenbehand-lung (Resektion der rippen, eroffnung der brusthohle, partielleentfernun der lunge) (1882) Wiener Med Wschr., 20, pp. 589-591Ehrenhaft, J.L., Pulmonary resections for metastatic lesions (1951) AMA Arch Surg., 63 (3), pp. 326-336. , http://dx.doi.org/10.1001/archsurg.1951.01250040332007, PMid:14868186Fujisawa, T., Yamaguchi, Y., Saitoh, Y., Sekine, Y., Iizasa, T., Mitsunaga, S., Factors influencing survival following pulmonary resection for metastatic colorectal carcinoma (1996) Tohoku J Exp Med., 180 (2), pp. 153-160. , http://dx.doi.org/10.1620/tjem.180.153, PMid:9111764Dellai, R.C.A., Chojniak, R., Marques, E., Younes, R.N., Detecção de nódulos pulmonares por tomografia computadorizada em pacientes com metástases pulmonares submetidos à cirurgia (1994) J Pneumol., 20 (SUPPL. 3), p. 28Thomford, N.R., Woolner, L.B., Clagett, O.T., The surgical treatment of metastatic tumors in the lungs (1965) J Thorac Cardiovasc Surg., 49, pp. 357-363. , PMid:14265951Morales-Blanhir, J.E., Palafox Vidal, C.D., Rosas Romero Mde, J., García Castro, M.M., Londono Villegas, A., Zamboni, M., Six-minute walk test: A valuable tool for assessing pulmonary impairment (2011) J Bras Pneumol., 37 (1), pp. 110-117. , http://dx.doi.org/10.1590/S1806-37132011000100016, PMid:21390439Younes, R.N., Haddad, F., Ferreira, F., Gross, J.L., Surgical removal of pulmonary metastasis: Prospective study in 182 patients [Article in Portuguese] (1998) Rev Assoc Med Bras., 44 (3), pp. 218-225. , PMid:9755551Moore, K.H., McCaughan, B.C., Surgical resection for pulmonary metastases from colorectal cancer (2001) ANZ J Surg., 71 (3), pp. 143-146. , http://dx.doi.org/10.1046/j.1440-1622.2001.02057.xPfannschmidt, J., Muley, T., Hoffmann, H., Dienemann, H., Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: Experiences in 167 patients (2003) J Thorac Cardiovasc Surg., 126 (3), pp. 732-739. , http://dx.doi.org/10.1016/S0022-5223(03)00587-7Rena, O., Casadio, C., Viano, F., Cristofori, R., Ruffini, E., Filosso, P.L., Pulmonary resection for metastases from colorectal cancer: Factors influencing prognosis. Twenty-year experience (2002) Eur J Cardiothorac Surg., 21 (5), pp. 906-912. , http://dx.doi.org/10.1016/S1010-7940(02)00088-XSaito, Y., Omiya, H., Kohno, K., Kobayashi, T., Itoi, K., Teramachi, M., Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment (2002) J Thorac Cardiovasc Surg., 124 (5), pp. 1007-1013. , http://dx.doi.org/10.1067/mtc.2002.125165, PMid:12407386Toscano, E., (1991) Tratamento cirúrgico das metástases nodulares do pulmão, , [thesis] Rio de Janeiro: Universidade Federal FluminenseRama, N., Monteiro, A., Bernardo, J.E., Eugénio, L., Antunes, M.J., Lung metastases from colorectal cancer: Surgical resection and prognostic factors (2009) Eur J Cardiothorac Surg., 35 (3), pp. 444-449. , http://dx.doi.org/10.1016/j.ejcts.2008.10.047, PMid:19136273Pfannschmidt, J., Dienemann, H., Hoffmann, H., Surgical resection of pulmonary metastases from colorectal cancer: A systematic review of published series (2007) Ann Thorac Surg., 84 (1), pp. 324-338. , http://dx.doi.org/10.1016/j.athoracsur.2007.02.093, PMid:17588454Ike, H., Shimada, H., Ohki, S., Togo, S., Yamaguchi, S., Ichikawa, Y., Results of aggressive resection of lung metastases from colorectal carcinoma detected by intensive follow-up (2002) Dis Colon Rectum., 45 (4), pp. 468-473. , http://dx.doi.org/10.1007/s10350-004-6222-0, discussion 473-5 PMid:12006927Inoue, M., Ohta, M., Iuchi, K., Matsumura, A., Ideguchi, K., Yasumitsu, T., Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma (2004) Ann Thorac Surg., 78 (1), pp. 238-244. , http://dx.doi.org/10.1016/j.athoracsur.2004.02.017, PMid:15223436Monteiro, A., Arce, N., Bernardo, J., Eugénio, L., Antunes, M.J., Surgical resection of lung metastases from epithelial tumors (2004) Ann Thorac Surg., 77 (2), pp. 431-437. , http://dx.doi.org/10.1016/j.athoracsur.2003.06.012, PMid:14759411Groeger, A.M., Kandioler, M.R., Mueller, M.R., End, A., Eckersberger, F., Wolner, E., Survival after surgical treatment of recurrent pulmonary metastases (1997) Eur J Cardiothorac Surg., 12, pp. 703-705. , http://dx.doi.org/10.1016/S1010-7940(97)00239-XMauro Rossi, B., Lopes, A., Paulo Kowalski, L., de Oliveira Regazzini, R.C., Prognostic factors in 291 patients with pulmonary metastases submitted to thoracotomy (1995) Sao Paulo Med J., 113 (3), pp. 910-916. , http://dx.doi.org/10.1590/S1516-31801995000300005, PMid:8728726Kanemitsu, Y., Kato, T., Hirai, T., Yasui, K., Preoperative probability model for predicting overall survival after resection of pulmonary metastases from colorectal cancer (2004) Br J Surg., 91 (1), pp. 112-120. , http://dx.doi.org/10.1002/bjs.4370, PMid:14716804Lee, W.S., Yun, S.H., Chun, H.K., Lee, W.Y., Yun, H.R., Kim, J., Pulmonary resection for metastases from colorectal cancer: Prognostic factors and survival (2007) Int J Colorectal Dis., 22 (6), pp. 699-704. , http://dx.doi.org/10.1007/s00384-006-0218-2, PMid:1710910
Descriptive analysis of and overall survival after surgical treatment of lung metastases
No full textTo describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. Methods: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. Results: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% Cl: 1.09-3.06; p = 0.02). Conclusions: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases396650658Descrever características demográficas, resultados operatórios, complicações pós-operatórias e taxa de sobrevida global em pacientes com metástases pulmonares tratados cirurgicamente. Análise retrospectiva de 119 pacientes submetidos a um total de 154 cirurgias de ressecção de metástase pulmonar entre 1997 e 2011. Resultados: Do total de 119 pacientes, 68 (57,1%) eram do sexo masculino, e 108 (90,8%) eram brancos. A mediana de idade foi de 52 anos (variação, 15-75 anos). Nessa amostra, 63 pacientes (52,9%) apresentaram comorbidades, sendo as mais frequentes hipertensão arterial sistêmica (69,8%) e diabetes (19,0%). Tumores primários colorretais (47,9%) e musculoesqueléticos (21,8%) foram os principais sítios de origem das metástases. Aproximadamente 24% dos pacientes foram submetidos a mais de uma ressecção das lesões, e 71% fizeram tratamento adjuvante prévio à metastasectomia. A taxa de recidiva de metástase pulmonar foi de 19,3%. A mediana do intervalo livre de doença foi de 23 meses. A principal via de acesso usada foi toracotomia (78%), e o tipo de ressecção mais frequente foi em cunha e segmentectomia (51%). O índice de complicações pós-operatórias foi de 22% e o de mortalidade perioperatória foi de 1,9%. As taxas de sobrevida global em 12, 36, 60 e 120 meses foram, respectivamente, de 96%, 77%, 56% e 39%. A análise de Cox confirmou que complicações nos primeiros 30 dias pós-operatórios associaram-se a pior prognóstico (hazard ratio = 1,81; IC95%: 1,09-3,06; p = 0,02). Conclusões: O tratamento cirúrgico das metástases pulmonares oriundas de diferentes sítios tumorais é efetivo e seguro, com boa sobrevida global, especialmente nos casos com um menor número de lesões pulmonare
