Humberto Alves de Oliveira

Experimental selective sympathicotomy (ramicotomy) and sympathetic regeneration

Ramicotomy is a surgical procedure, with less adverse effects than conventional sympathectomy, however, it was abandoned due to the high recurrence rate. Twenty-eight pigs underwent bilateral videothoracoscopic ramicotomy and were divided into five groups. The animals were sacrificed at 15th, 45th, 90th, 135th and 180th postoperative days (POD). The segments were removed and evaluated for macroscopic regeneration and histological analysis. The data were compared to the control group of 10 intact segments of the sympathetic. There was no macroscopic regeneration on the 15th POD, and present on 41.6% on the 180th POD (P<0.05). The Schwann cells presented a similar evolution in both rami beginning at the 45th POD, with a smaller count in the gray rami. The collagen and reticular fibers presented a negative correlation (r=-0.414; P<0.01). The deposition of the collagen fibers was greater in the gray rami with a peak deposition on the 135th POD and a diminishing rate in the 180th POD (P<0.05). Ramicotomy allows complete section of all rami communicantes of the sympathetic ganglia. The histological regeneration might be greater than the recurrence rates of clinical symptoms seen in a human being due to non-functional regenerations.

Video-assisted thoracoscopic surgery yields better outcomes than thoracotomy for anatomical lung resection in Brazil: a propensity score-matching analysis using the Brazilian Society of Thoracic Surgery database

OBJECTIVES The use of video-assisted anatomical lung resection is increasingly widespread for lung cancer and non-neoplastic diseases, showing excellent results. Nonetheless, a comparative analysis of the benefits of this technique has yet to be conducted in Latin America, a region with a completely different case mix from the USA or Europe. The purpose of this study was to compare the outcomes of video-assisted thoracoscopic surgery (VATS) and open thoracotomy (OT) for anatomical lung resection in patients included on the Brazilian Society of Thoracic Surgery (BSTS) database. METHODS Using propensity score matching, we conducted an analysis of 1355 patients who underwent anatomical lung resection (704 OT and 651 VATS) registered in the BSTS database between August 2015 and December 2016. Propensity score matching was performed using the following baseline characteristics: age at surgery, gender, comorbidities, pulmonary lung function, type of resection and cancer and non-cancer diagnosis. The propensity score-matched sample comprised a well-matched group of 890 patients. The main outcomes tested were mortality, complications and major cardiopulmonary complications based on the European Society of Thoracic Surgeons (ESTS) database definitions and terminology. RESULTS Standardized differences of means and proportions suggested that an adequate balance had been achieved. Major cardiopulmonary complications were shown to be more frequent in patients who underwent OT (16.0% compared with 9.2% in VATS patients; odds ratio  = 1.87, 95% confidence interval 1.25-2.80) and the overall complications rate was higher among patients who underwent OT (30.1% compared with 21.8% in VATS patients; odds ratio = 1.55, 95% confidence interval 1.17-2.05). No statistically significant difference in mortality rate was observed between OT (2.5%) and VATS (1.8%) (odds ratio = 1.38, 95% confidence interval 0.54-3.50). CONCLUSIONS In Brazil, the rate of complications associated with minimally invasive surgery (VATS) for anatomical lung resection is significantly lower than that of conventional OT.

Hemodynamic effects of experimental acute right ventricular overload

FUNDAMENTO: A sobrecarga ventricular direita aguda esta associada a situacoes clinicas de elevada morbimortalidade, tais como: resseccoes pulmonares extensas, tromboembolismo pulmonar, transplante pulmonar e edema pulmonar das altitudes. Alguns pontos de sua fisiopatologia permanecem obscuros. OBJETIVO: Avaliar os efeitos hemodinâmicos da sobrecarga ventricular direita aguda experimental em suinos. METODOS: A sobrecarga ventricular direita foi induzida pela oclusao das arterias pulmonares atraves de ligaduras. Vinte porcos foram utilizados no estudo, sendo alocados em 04 grupos: um controle, nao submetido a oclusao vascular pulmonar, e tres de sobrecarga ventricular direita submetidos a oclusao das seguintes arterias pulmonares: SVD1 (arteria pulmonar esquerda); SVD2 (arteria pulmonar esquerda e do lobo inferior direito) e SVD3 (arteria pulmonar esquerda, do lobo inferior direito e do lobo mediastinal), obstruindo a vasculatura pulmonar em 42, 76 e 82,0% respectivamente. Variaveis de hemodinâmica foram medidas a cada 15 minutos durante a uma hora do estudo. Na analise estatistica, foram utilizados ajustes de modelos lineares mistos com estrutura de variâncias e covariâncias. RESULTADOS: Nas comparacoes intergrupais, houve aumento significativo da frequencia cardiaca (p = 0,004), pressao arterial pulmonar media (p = 0,001) e pressao capilar pulmonar (p < 0,0001). Houve reducao significativa da pressao arterial media (p = 0,01) e do indice sistolico (p = 0,002). Nao houve diferenca significativa no indice cardiaco (p = 0,94). CONCLUSAO: Apesar da intensa sobrecarga ventricular direita promovida pela obstrucao de 82,0% da vasculatura pulmonar e pelo aumento significativo da pressao arterial pulmonar nao houve disfuncao cardiovascular severa e/ou choque circulatorio no periodo estudado.BACKGROUND Acute right ventricular overload is associated with high morbidity and mortality clinical situations such as: extensive lung resection, pulmonary thromboembolism, lung transplantation and high altitude pulmonary edema. Some points of its pathophysiology remain unclear. OBJECTIVE To assess the hemodynamic effects of experimental acute right ventricular overload in pigs. METHODS Right ventricular overload was induced through the occlusion of the pulmonary arteries using ligationss. Twenty pigs were used in the study, divided into 04 groups: one control group not subject to pulmonary vascular occlusion, and three right ventricular overload groups subject to occlusion of the following pulmonary arteries: SVD1 (left pulmonary artery); SVD2 (left pulmonary artery and right lower lobe) and SVD3 (left pulmonary artery, right lower lobe and mediastinal lobe), obstructing the pulmonary vasculature in 42, 76 and 82.0% respectively. Hemodynamic variables were measured every 15 minutes during one hour of study. The statistical analysis employed mixed linear models with variance and covariance structures. RESULTS Group comparisons revealed significant increases in heart rate (p = 0.004), mean pulmonary artery pressure (p = 0.001) and pulmonary capillary wedge pressure (p < 0.0001). There was no significant difference in cardiac index (p = 0.94). CONCLUSION Despite the severe right ventricular overload promoted by 82.0% obstruction of the pulmonary vasculature and the significant increase in pulmonary arterial pressure, there was no severe cardiovascular dysfunction and/or circulatory shock during the study period.

P1.20: Lung Resection Analysis From Brazilian Society of Thoracic Surgery Database: Track: Early Stage NSCLC (Stage I - III)

Results: This series included 11 patients aged 50y or less. Ten patients were women (90.9%), nine of them were never-smokers (90%). 81.8% had lung adenocarcinoma (n1⁄49), 9.1% large-cell carcinoma (n1⁄41) and 9.1% giant-cell carcinoma (n1⁄41). Nine patients were diagnosed at stage-IV and two patients at stages IA and IIB. Six patients (54.5%) were positive for either EGFR mutations (n1⁄43) or EML4-ALK fusions (n1⁄43) and two of them received TT with a tyrosine kinase inhibitor. Interestingly, all patients under 40y were mutated. Regarding to follow-up, 63.6% were not able to be followed, 27.3% died. Only one patient, who received TT with erlotinib, was followed-up at our institution (Table 1).

Efeitos hemodinâmicos da sobrecarga ventricular direita aguda experimental

FUNDAMENTO: A sobrecarga ventricular direita aguda esta associada a situacoes clinicas de elevada morbimortalidade, tais como: resseccoes pulmonares extensas, tromboembolismo pulmonar, transplante pulmonar e edema pulmonar das altitudes. Alguns pontos de sua fisiopatologia permanecem obscuros. OBJETIVO: Avaliar os efeitos hemodinâmicos da sobrecarga ventricular direita aguda experimental em suinos. METODOS: A sobrecarga ventricular direita foi induzida pela oclusao das arterias pulmonares atraves de ligaduras. Vinte porcos foram utilizados no estudo, sendo alocados em 04 grupos: um controle, nao submetido a oclusao vascular pulmonar, e tres de sobrecarga ventricular direita submetidos a oclusao das seguintes arterias pulmonares: SVD1 (arteria pulmonar esquerda); SVD2 (arteria pulmonar esquerda e do lobo inferior direito) e SVD3 (arteria pulmonar esquerda, do lobo inferior direito e do lobo mediastinal), obstruindo a vasculatura pulmonar em 42, 76 e 82,0% respectivamente. Variaveis de hemodinâmica foram medidas a cada 15 minutos durante a uma hora do estudo. Na analise estatistica, foram utilizados ajustes de modelos lineares mistos com estrutura de variâncias e covariâncias. RESULTADOS: Nas comparacoes intergrupais, houve aumento significativo da frequencia cardiaca (p = 0,004), pressao arterial pulmonar media (p = 0,001) e pressao capilar pulmonar (p < 0,0001). Houve reducao significativa da pressao arterial media (p = 0,01) e do indice sistolico (p = 0,002). Nao houve diferenca significativa no indice cardiaco (p = 0,94). CONCLUSAO: Apesar da intensa sobrecarga ventricular direita promovida pela obstrucao de 82,0% da vasculatura pulmonar e pelo aumento significativo da pressao arterial pulmonar nao houve disfuncao cardiovascular severa e/ou choque circulatorio no periodo estudado.BACKGROUND Acute right ventricular overload is associated with high morbidity and mortality clinical situations such as: extensive lung resection, pulmonary thromboembolism, lung transplantation and high altitude pulmonary edema. Some points of its pathophysiology remain unclear. OBJECTIVE To assess the hemodynamic effects of experimental acute right ventricular overload in pigs. METHODS Right ventricular overload was induced through the occlusion of the pulmonary arteries using ligationss. Twenty pigs were used in the study, divided into 04 groups: one control group not subject to pulmonary vascular occlusion, and three right ventricular overload groups subject to occlusion of the following pulmonary arteries: SVD1 (left pulmonary artery); SVD2 (left pulmonary artery and right lower lobe) and SVD3 (left pulmonary artery, right lower lobe and mediastinal lobe), obstructing the pulmonary vasculature in 42, 76 and 82.0% respectively. Hemodynamic variables were measured every 15 minutes during one hour of study. The statistical analysis employed mixed linear models with variance and covariance structures. RESULTS Group comparisons revealed significant increases in heart rate (p = 0.004), mean pulmonary artery pressure (p = 0.001) and pulmonary capillary wedge pressure (p < 0.0001). There was no significant difference in cardiac index (p = 0.94). CONCLUSION Despite the severe right ventricular overload promoted by 82.0% obstruction of the pulmonary vasculature and the significant increase in pulmonary arterial pressure, there was no severe cardiovascular dysfunction and/or circulatory shock during the study period.

Efectos hemodinámicos de la sobrecarga ventricular derecha aguda experimental

FUNDAMENTO: A sobrecarga ventricular direita aguda esta associada a situacoes clinicas de elevada morbimortalidade, tais como: resseccoes pulmonares extensas, tromboembolismo pulmonar, transplante pulmonar e edema pulmonar das altitudes. Alguns pontos de sua fisiopatologia permanecem obscuros. OBJETIVO: Avaliar os efeitos hemodinâmicos da sobrecarga ventricular direita aguda experimental em suinos. METODOS: A sobrecarga ventricular direita foi induzida pela oclusao das arterias pulmonares atraves de ligaduras. Vinte porcos foram utilizados no estudo, sendo alocados em 04 grupos: um controle, nao submetido a oclusao vascular pulmonar, e tres de sobrecarga ventricular direita submetidos a oclusao das seguintes arterias pulmonares: SVD1 (arteria pulmonar esquerda); SVD2 (arteria pulmonar esquerda e do lobo inferior direito) e SVD3 (arteria pulmonar esquerda, do lobo inferior direito e do lobo mediastinal), obstruindo a vasculatura pulmonar em 42, 76 e 82,0% respectivamente. Variaveis de hemodinâmica foram medidas a cada 15 minutos durante a uma hora do estudo. Na analise estatistica, foram utilizados ajustes de modelos lineares mistos com estrutura de variâncias e covariâncias. RESULTADOS: Nas comparacoes intergrupais, houve aumento significativo da frequencia cardiaca (p = 0,004), pressao arterial pulmonar media (p = 0,001) e pressao capilar pulmonar (p < 0,0001). Houve reducao significativa da pressao arterial media (p = 0,01) e do indice sistolico (p = 0,002). Nao houve diferenca significativa no indice cardiaco (p = 0,94). CONCLUSAO: Apesar da intensa sobrecarga ventricular direita promovida pela obstrucao de 82,0% da vasculatura pulmonar e pelo aumento significativo da pressao arterial pulmonar nao houve disfuncao cardiovascular severa e/ou choque circulatorio no periodo estudado.BACKGROUND Acute right ventricular overload is associated with high morbidity and mortality clinical situations such as: extensive lung resection, pulmonary thromboembolism, lung transplantation and high altitude pulmonary edema. Some points of its pathophysiology remain unclear. OBJECTIVE To assess the hemodynamic effects of experimental acute right ventricular overload in pigs. METHODS Right ventricular overload was induced through the occlusion of the pulmonary arteries using ligationss. Twenty pigs were used in the study, divided into 04 groups: one control group not subject to pulmonary vascular occlusion, and three right ventricular overload groups subject to occlusion of the following pulmonary arteries: SVD1 (left pulmonary artery); SVD2 (left pulmonary artery and right lower lobe) and SVD3 (left pulmonary artery, right lower lobe and mediastinal lobe), obstructing the pulmonary vasculature in 42, 76 and 82.0% respectively. Hemodynamic variables were measured every 15 minutes during one hour of study. The statistical analysis employed mixed linear models with variance and covariance structures. RESULTS Group comparisons revealed significant increases in heart rate (p = 0.004), mean pulmonary artery pressure (p = 0.001) and pulmonary capillary wedge pressure (p < 0.0001). There was no significant difference in cardiac index (p = 0.94). CONCLUSION Despite the severe right ventricular overload promoted by 82.0% obstruction of the pulmonary vasculature and the significant increase in pulmonary arterial pressure, there was no severe cardiovascular dysfunction and/or circulatory shock during the study period.