Carlos Alberto Almeida de Araújo

Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction

OBJECTIVE This prospective study aimed at investigating predictive factors for compensatory sweating after thoracoscopic sympathectomy. METHODS From 2000 to 2002, 80 patients (53 females and 27 males) underwent thoracoscopic sympathectomy to treat hyperhidrosis. Patient ages ranged from 12 to 56 years, and the mean post-operative follow-up period was 42.51 +/- 5.98 months. Patient satisfaction with the results was evaluated through the use of a rating scale. The procedure was performed bilaterally: at the T2 level for facial hyperhidrosis; at the T3-T4 level for axillary hyperhidrosis; and at the T3 level for palmar hyperhidrosis. RESULTS Post-operatively, 68 patients (85.0%) presented compensatory sweating, which was classified as mild in 23 (33.8%), moderate in 23 (33.8%) and severe in 22 (32.4%). Considering the final surgical results, 70 patients (87.5%) were satisfied with the outcome of the operation, whereas 10 patients (12.5%) were dissatisfied. The level of patient satisfaction varied according to gender, age, body mass index (BMI) and extent of denervation. The compensatory sweating was more severe on the abdomen and back than on the legs. CONCLUSIONS Although compensatory sweating, which is a common adverse effect of sympathectomy, occurred in the majority of cases, the level of patient satisfaction was high. The best candidates for thoracoscopic sympathectomy are young adult women with a BMI < 24.9 kg/m(2).

Efeitos da simpaticotomia endoscópica sobre as artérias carótidas e vertebrais na terapêutica cirúrgica da hiperidrose primária

OBJETIVOS: Analisar, em pacientes submetidos a simpaticotomia videotoracoscopica para tratamento da Hiperidrose Primaria (HP), as consequencias hemodinâmicas da desnervacao vascular das arterias carotidas e vertebrais apos a trans-seccao cirurgica da cadeia simpatica toracica (simpaticotomia), atraves da mensuracao de parâmetros ultra-sonograficos. METODO: Vinte e quatro pacientes portadores de HP submetidos a quarenta e oito simpaticotomias toracicas endoscopicas foram avaliados atraves da mensuracao da velocidade de pico sistolico (VPS), velocidade de pico diastolico (VPD), indice de pulsatibilidade (IP) e indice de resistencia (IR) nas arterias carotidas comuns, internas e externas, alem da arteria vertebral bilateralmente usando o eco-doppler duplex scan. As avaliacoes foram realizadas antes da intervencao cirurgica e trinta dias apos o procedimento. O teste de Wilcoxon foi usado na analise das diferencas entre as variaveis antes e depois da simpaticotomia. RESULTADOS: A simpaticotomia no nivel de T3 foi a trans-seccao mais realizada (95,83%), seja isoladamente (25%) ou associada a T4 (62,50%) ou a T2 (8,33%). Houve aumento significativo no IR e no IP da arteria carotida comum bilateralmente (p<0,05). A VPD da arteria carotida interna diminuiu em ambos os lados (p<0,05). A VPS e a VPD da arteria vertebral direita tambem aumentaram (p<0,05). Achados assimetricos foram observados, de modo que arterias do lado direito foram as mais frequentemente afetadas. CONCLUSOES: Alteracoes hemodinâmicas foram observadas nas arterias vertebral e carotida apos simpaticotomia para tratamento de HP. VPS foi o parâmetro mais frequentemente alterado, principalmente nas arterias do lado direito, representando alteracoes assimetricas significantes nas arterias carotida e vertebral. Entretanto, sao necessarias pesquisas subsequentes para verificar se essas alteracoes sao definitivas ou temporarias, uma vez que as inferencias clinicas somente terao validacao se as alteracoes forem permanentes.

Influência do corticóide na cicatrização da anastomose traqueal sob tensão em cães

OBJETIVO: Trabalho com o objetivo de analisar a frequencia e intensidade de estenose traqueal apos resseccao e anastomose sob tensao; acao da metilprednisolona como agente profilatico da estenose traqueal e a caracterizacao dos fenomenos da cicatrizacao com e sem o uso de corticoide. METODOS: Foram utilidados 20 caes mesticos pesando 13± 5 Kg divididos aleatoriamente em dois grupos. No grupo A(n=10) nao foi usado corticoide (controle). No grupo B foi usada a metilprednisolona IM na dose 10mg/Kg. Sob anestesia geral com intubacao orotraqueal foram ressecados 3 aneis traqueais de todos animais, de modo que a forca para aproximacao das extremidades da traqueia foi uniformemente de 300gf. Apos 30 dias de observacao os animais foram tratados com dose letal de anestesico e KCl, quando foi ressecada a traqueia para medida dos diâmetros internos da anastomose e da traqueia normal, com auxilio de paquimetro digital. Na analise histopatologica com as coloracoes HE e tricromico de Masson utilizou-se sistema digitalizado para quantificar as estruturas dos tecidos em cicatrizacao. RESULTADOS: Foi observado maior indice de estenose da traqueia no grupo A que nao utilizou corticoide, do que no grupo B, com diferenca significante (p<0,01). A reacao inflamatoria, formacao de fibras colagenas e de fibroblastos ocorreu com densidade media mais intensa no grupo A, caracterizando uma diferenca significante (p<0,01). CONCLUSAO: Os dados permitem concluir que o uso da metilprednisolona em caes submetidos a resseccao de traqueia e anastomose sob tensao contribuiu para diminuir a intensidade e frequencia da estenose na zona da anastomose e fez reduzir a reacao inflamatoria nos tecidos em cicatrizacao.

Anatomic pulmonary resection by video-assisted thoracoscopy: the Brazilian experience (VATS Brazil study)

ABSTRACT Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority-521 (89.8%)-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries.

Actinomicose pulmonar na forma pseudotumoral: uma apresentação rara

Some lung diseases are true diagnostic challenges due to their various clinical presentations. Actinomycosis is one such disease, potentially affecting various organs and systems. We report the case of a patient with pulmonary actinomycosis as a pseudotumor, which is usually only diagnosed by thoracotomy or thoracoscopy.

Lesão complexa da traqueia: correção com retalho pediculado de músculo intercostal

Esophageal reconstruction is one of the most complex types of gastrointestinal surgery, principally when it is performed using minimally invasive techniques. The procedure is associated with various complications, such as anastomotic dehiscence, chylothorax, esophageal necrosis and fistulae. We report the case of a patient diagnosed with epidermoid carcinoma in the distal third of the esophagus. The patient was submitted to esophagectomy by video-assisted thoracoscopy and laparoscopy. During the operation, the left main bronchus was injured, and this required immediate surgical correction. In the postoperative period, the patient presented with acute respiratory failure and profuse air leak through the thoracic drains and through the cervical surgical wound. The patient underwent a second surgical procedure, during which a large lesion was discovered in the membranous wall of the trachea. The lesion was corrected with an intercostal muscle pedicle flap.