Anderson Oliveira

Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients

OBJECTIVE: To determine morbidity and mortality rates by risk category in accordance with the American College of Chest Physicians guidelines, to determine what role pulmonary function tests play in this categorization process, and to identify risk factors for perioperative complications (PCs). METHODS: This was a historical cohort study based on preoperative and postoperative data collected for cases of lung cancer diagnosed or suspected between 2001 and 2010. RESULTS: Of the 239 patients evaluated, only 13 (5.4%) were classified as being at high risk of PCs. Predicted postoperative FEV1 (FEV1ppo) was sufficient to define the risk level in 156 patients (65.3%); however, cardiopulmonary exercise testing (CPET) was necessary for identifying those at high risk. Lung resection was performed in 145 patients. Overall morbidity and mortality rates were similar to those reported in other studies. However, morbidity and mortality rates for patients at an acceptable risk of PCs were 31.6% and 4.3%, respectively, whereas those for patients at high risk were 83.3% and 33.3%. Advanced age, COPD, lobe resection, and lower FEV1ppo were correlated with PCs. CONCLUSIONS: Although spirometry was sufficient for risk assessment in the majority of the population studied, CPET played a key role in the identification of high-risk patients, among whom the mortality rate was seven times higher than was that observed for those at an acceptable risk of PCs. The risk factors related to PCs coincided with those reported in previous studies.

Open anterior dislocation of the hip in an adult: a case report and review of literature

Open anterior hip dislocation is a rare condition and results from high‐energy trauma. Ten cases of open anterior dislocation have been described in the literature so far. Its rarity is due to the inherent stability of the joint, its deep position in the pelvis, with strong ligaments and bulky muscles around the articulation. Several factors influence the prognosis, such as the degree of compounding, the associated soft tissue injuries, the age of the patient and, mainly, the delay in reduction. The main complications are: arthrosis of the hip, with incidence of 50% of cases, when associated with fractures of the femoral head; and osteonecrosis of the femoral head, with incidence between 1.7 and 40% (in closed anterior dislocation). Because of the rarity and the potential disability of this lesion, we report a case in a 46‐year‐old man, involved in an automobile accident. The hip was reduced (anterior superior dislocation) in the first three hours of the trauma. The patient was kept non‐weight bearing until sixth week, with complete weight bearing after 10th week. After one year follow‐up, the functional result was poor (Harris Hip Score: 52), probably because of the associated labral tear, but without signs of osteonecrosis of the femoral head in magnetic resonance imaging.

Epidemiological profile of patients diagnosed with athletic pubalgia

Objective To evaluate the clinical and epidemiological characteristics of pubalgia in patients from a Sports Medicine Center. Methods Data analysis from medical records of patients with athletic pubalgia attended to from January 2007 to January 2015. The diagnosis was made by an experienced hip surgeon, complemented with pelvic X-ray, abdominal wall ultrasound, and magnetic resonance imaging of the pelvis. Results Among 43 patients, 42 were men, with mean age of 33 years. As for sports, 25 (58.1%) athletes were soccer players and 13 (30.2%) were runners; 37.2% were professional athletes. Inguinal hernia was diagnosed in 20.9% of patients, showing the importance of its routine search in these patients. Treatment duration ranged from 1 to 12 months and 95.2% of the patients returned to sport. Conclusion This study presented the epidemiological characteristics of patients diagnosed with athletic pubalgia attended to in a reference medical center and demonstrated the prevalence of this lesion in male patients, soccer players and runners. It also disclosed a high success rate of the nonoperative treatment, and high rate of return to sport after treatment.

Influência das características mamárias na cintilografia miocárdica pelo método Monte Carlo

FUNDAMENTO: Por la reduccion de la especificidad asociada a la perdida de informacion, la influencia de la atenuacion de las mamas es de fundamental importancia en estudios de perfusion del miocardio. Entre tanto, a pesar de que varios estudios han sido realizados a lo largo de los ultimos anos, poco se ha evolucionado para determinar con precision la influencia de las caracteristicas de las mamas sobre la calidad de la camara gamma miocardica, evitando exposiciones adicionales de radiacion a las pacientes. OBJETIVO: El objetivo de este estudio es cuantificar la atenuacion de fotones por las mamas, en estudios de perfusion del miocardio con 99mTc, de acuerdo con diferentes tamanos y composiciones. METODOS: Cada mama fue asumida como siendo un cubo compuesto de tejido adiposo y fibroglandular. Los datos referentes a los fotones de 99mTc fueron analizados en un modelo de Monte Carlo. Variamos el espesor y la composicion de las mamas y analizamos las interferencias en la atenuacion. Fue empleado el software EGS 4 para las simulaciones. RESULTADOS: Fijando el espesor de una mama, la variacion de su composicion acarrea un aumento maximo de 2,3% en el numero de fotones atenuados. En contrapartida, manteniendose una composicion del tejido mamario fija, la diferencia en la atenuacion de fotones fue de 45,0%, siendo en media de 6,0% para cada aumento de centimetro en el espesor de la mama. CONCLUSION: La simulacion por Monte Carlo demostro que la influencia de los espesores de las mamas en la atenuacion de fotones en camara gamma del miocardio con 99mTc es mucho mayor que la influencia de sus composiciones.