João Paulo Vieira

Simpatectomia torácica por videotoracoscopia para tratamento da hiperidrose primária: estudo retrospectivo de 521 casos comparando diferentes níveis de ablação

OBJECTIVE To compare different levels of ablation in terms of the degree of patient satisfaction and extent of postoperative reflex sweating in sympathectomized patients. METHODS A retrospective study involving 521 patients with primary hyperhidrosis, submitted to thoracic sympathectomy at the Monte Sinai Hospital and University Hospital of the Federal University of Juiz de Fora, from January of 2001 to December 2005. All patients were submitted to thermal ablation of the sympathetic stem and were divided into three groups: up to T2 (group I, n = 162); up to T3 (group II, n = 65); and up to T4 (group III, n = 294). RESULTS Optimal postoperative control of palmar/axillary hyperhidrosis was achieved in, respectively, 94/82% of the patients of group I, 89/89% of those in group II and 80/80% of those in group III. Postoperative reflex sweating was observed in 67% of the patients in groups I and II, compared with 61.29% of those in group III. Severe reflex sweating occurred in 32% of the group I patients, 9% of the group II patients and 4% of the group III patients. CONCLUSION Sympathectomy provided excellent patient satisfaction and a low incidence of complications. There was no significant difference between the levels of ablation in terms of reflex sweating, although the intensity of this complication decreased when lower levels of blockage, principally at the T4 level, were employed.

Amiloidose pulmonar: relato de caso de achado radiológico da apresentação nodular em grande fumante

Pulmonary amyloidosis is a rare disease, characterized by extracellular deposition of fibrillary protein in the lungs. Amyloidosis is a generic term for a heterogeneous group of diseases, including Alzheimers disease and type 2 diabetes mellitus. In the respiratory system, it appears in various forms: tracheobronchial; nodular pulmonary; and alveolar septal (diffuse parenchymal). We present the case of a woman who was a 20 pack-year smoker and had nodular pulmonary amyloidosis, as diagnosed through tests performed prior to laparoscopic cholecystectomy.

Pseudotumor inflamatório do pulmão

Inflammatory pseudotumor of the lung is a rare condition that represents a dilemma because the radiographic, macroscopic and pathological aspects mimic a malignant process. Herein, we report the case of a patient complaining of respiratory difficulty who, after being appropriately assessed, was submitted to exploratory thoracotomy. An initial diagnosis of pseudotumor was subsequently confirmed through immunohistochemistry. In addition to presenting data relating to clinical history, we also discuss radiographic, histopathological and surgical aspects, as well as treatment options.

Simpatectomia torácica por videotoracoscopia

1. Physician specialized in Thoracic Surgery. Universidade Federal de Juiz de Fora – UFJF, Federal University of Juiz de Fora – Juiz de Fora (MG) Brazil.2. Assistant Professor in the Surgery Department of the Universidade Federal de Juiz de Fora – UFJF, Federal University of Juiz de Fora – Juiz de Fora (MG) Brazil.3. Masters in Thoracic Surgery. Faculty of Medical Sciences. School of Medicine and Health Sciences of Juiz de Fora – SUPREMA – Juiz de Fora (MG) Brazil.4. Resident in Thoracic Surgery. Universidade Federal de Juiz de Fora – UFJF, Federal University of Juiz de Fora – Juiz de Fora (MG) Brazil.5. Sixth-year Medical Student. Universidade Federal de Juiz de Fora – UFJF, Federal University of Juiz de Fora – Juiz de Fora (MG) Brazil.6. Fourth-year Medical Student. School of Medicine and Health Sciences of Juiz de Fora – SUPREMA – Juiz de Fora (MG) Brazil.

Lesões da traquéia e grandes brônquios

As lesoes traqueobronquicas sao raras, porem, no trauma de torax, envolvem grande risco de vida. As suas manifestacoes sao variaveis e nao e incomum o diagnostico ser protraido. O sucesso no diagnostico e tratamento, frequentemente, requer alto grau de suspeicao e a correcao cirurgica como metodo de escolha. Apos trauma fechado de torax, a ruptura da traqueia e dos bronquios principais, geralmente, ocorre nas proximidades da carina. O rompimento da arvore traqueobronquica, ocasionado por acidentes em alta velocidade, com alto impacto e grande liberacao de energia, geralmente esta associado a outras lesoes. Os sinais comumente presentes sao: enfisema subcutâneo, dispneia e hemoptise. Os achados radiologicos mais comuns incluem pneumotorax, pneumomediastino, fraturas de costelas e clavicula. As broncoscopias efetivamente rigida e flexivel sao considerados metodos diagnosticos eficazes, desde que manuseados por cirurgiao toracico treinado. O diagnostico precoce deve ser enfatizado, pois evita as complicacoes associadas ao reparo tardio das lesoes. O mecanismo etiologico, o diagnostico e os aspectos da terapeutica na literatura mundial sao revistos e discutidos.