Luís Carlos de Lima

Tratamento cirúrgico de crianças com pneumonia necrosante

OBJECTIVE To describe the results of the surgical treatment of children with necrotizing pneumonia. METHODS A retrospective analysis of the medical charts of 20 children diagnosed with necrotizing pneumonia and submitted to surgical treatment between March of 1997 and September of 2008 in the thoracic surgery departments of two hospitals in the city of Manaus, Brazil. We compiled data regarding age, gender, etiologic agent, indications for surgery, type of surgical resection performed, and postoperative complications. RESULTS The mean age of the patients was 30 months. Of the 20 patients studied, 12 (60%) were female. The most common etiologic agents were Staphylococcus aureus, in 5 patients (25%), and Klebsiella sp., in 2 (10%). The indications for surgery were sepsis, in 16 patients (80%), and bronchopleural fistula, in 4 (20%). The types of surgical procedures performed were lobectomy, in 12 patients (60%), segmentectomy, in 7 (35%), and bilobectomy, in 1 (5%). There were 8 patients (40%) who also underwent decortication. The postoperative complications were as follows: bronchopleural fistula, in 4 patients (20%); empyema, in 1 (5%); pneumatocele, in 1 (5%); and phlebitis of the left arm, in 1 (5%). Four (20%) of the patients died. CONCLUSIONS Surgical resection should be considered in patients with evidence of pulmonary necrosis. Resection is indicated in cases of severe sepsis, high output bronchopleural fistula, or acute respiratory failure that are refractory to clinical treatment.

Características de pacientes com câncer de pulmão na cidade de Manaus

OBJECTIVE: To analyze the characteristics of patients with lung cancer. METHODS: A retrospective descriptive study of patients receiving a histopathological diagnosis of lung cancer between 1995 and 2002 in the city of Manaus, Brazil. Data were collected from the medical archives of three hospitals. Statistical analyses were carried out, and survival curves were generated by means of an actuarial estimator. RESULTS: Of the 352 patients selected, 262 (74.4%) were male and 90 (25.6%) were female. The mean age was 62 years. The following histological types were identified: squamous cell carcinoma, 62.8%; adenocarcinoma, 24.7%; small cell carcinoma, 9.1%; and large cell carcinoma, 3.4%. The most common stages were stages IIIB and IV, in 45% and 21.5%, respectively. Of the total sample, 73.4% were submitted to treatment. Of these, 51.4% underwent radiotherapy; 16.6%, surgery; 15.8%, chemotherapy; and 16.2%, radiotherapy in association with chemotherapy. Cumulative survival rates were low: three-year survival was 6.5%, and five-year survival was 3.5%. CONCLUSIONS: In this group of patients with lung cancer, survival rates were considerably lower than those reported in the literature. This might be attributable to the limited access to the specialized health care system and the advanced stage of the disease at diagnosis.

Doença de Castleman associada a sarcoma de células dendríticas foliculares e miastenia gravis

Castlemans disease is an atypical lymphoproliferative disorder of unknown etiology, which might be associated with various clinical conditions, including autoimmune diseases and malignant neoplasms. We report the case of a 72-year-old female patient who was referred to the thoracic surgery department of Getulio Vargas University Hospital, in the city of Manaus, Brazil, for the resection of a posterior mediastinal tumor. Three months prior, the patient had been admitted to the ICU with signs of severe dyspnea, at which time she was diagnosed with myasthenia gravis. After the resection of the mediastinal tumor, the histopathological examination revealed hyaline vascular-type Castlemans disease, complicated by follicular dendritic cell sarcoma. At this writing, the patient was being treated with an anticholinesterase agent and corticosteroids for the control of myasthenia gravis.

Skin Depigmentation: Could it Be a Complication Caused by Thoracic Sympathectomy?

Primary hyperhidrosis is an idiopathic disorder, and its definitive treatment is obtained through thoracic sympathectomy. However, this procedure is not exempt from complications and compensatory sweating is the main inconvenience described. In this article, 2 patients were submitted to video-assisted thoracoscopic sympathectomy, and after approximately 8 months they noticed depigmentation of the region corresponding to the blockage of sympathetic stimulus. This fact could be explained by the possible effect of the nervous system on the melanocytes of human skin. Thus, patients with primary hyperhidrosis, who are candidates for thoracic sympathectomy and have brown skin, must be made aware of this possible complication.

Tumor carcinoide e sequestro pulmonar

Pulmonary sequestration is defined as a mass of lung tissue separated from the tracheobronchial tree and irrigated by an anomalous systemic artery. It is rarely seen in conjunction with lung neoplasms. We report the case of a 39-year-old female patient diagnosed with a carcinoid tumor, located in the intermediate bronchus and accompanied by bronchiectasis in the right lower lobe. The patient underwent thoracotomy for the resection of the affected area. During surgery, she presented with significant hemorrhage resulting from the transection of the anomalous artery that irrigated an intralobar pulmonary sequestration, which was located in right lower lobe and had not been identified in pre-operative examinations.

Chest wall reconstruction with titanium plates after desmoid tumor resection.

A reconstrucao da parede toracica se torna necessaria quando ha defeitos de parede com diâmetro maior que 5 cm que comprometam a dinâmica respiratoria. Seu objetivo e restaurar a integridade da parede, assim como manter a impermeabilizacao pleural, o padrao estetico do contorno do torax e a dinâmica respiratoria. Alem disso, objetiva-se proteger os orgaos vitais intratoracicos, evitando a herniacao pulmonar e a respiracao paradoxal e preservando a complacencia pulmonar.

Pleurodesis induction in rats by Copaiba (Copaifera multijuga Hayne) oil.

This study aims to assess and compare copaiba oleoresin of Copaifera multijuga and 0.5% silver nitrate for the induction of pleurodesis in an experimental model. Ninety-six male Wistar rats were divided into three groups: control (0.9% saline solution), copaiba (copaiba oil), and silver nitrate (0.5% silver nitrate). The substances were injected into the right pleural cavity and the alterations were observed macroscopically and microscopically at 24, 48, 72, and 504 h. The value of macroscopic alterations grade and acute inflammatory reaction grade means was higher in the 24 h copaiba group in relation to silver nitrate. Fibrosis and neovascularization means in the visceral pleura were higher in 504 h copaiba group in relation to the silver nitrate group. The grade of the alveolar edema mean was higher in the silver nitrate group in relation to the copaiba group, in which this alteration was not observed. The presence of bronchopneumonia was higher in the 24 h silver nitrate group (n = 4) in relation to the copaiba group (n = 0). In conclusion, both groups promoted pleurodesis, with better results in copaiba group and the silver nitrate group presented greater aggression to the pulmonary parenchyma.

Case ReportTympanic membrane perforation caused by traumatic asphyxia

Residencia Medica em Otorrinolaringologia (Medica Residente do 1o ano de Otorrinolaringologia).Hospital Universitario Getulio Vargas.Endereco para correspondencia: Fernando Luiz Westphal. Hospital Universitario Getulio Vargas, Coordenacao de Ensino e Pesquisa. Av. Aripuana, no 04, Praca 14 de Janeiro. Manaus - AM. Brasil. CEP: 69020-170.E-mail: f.l.westphal@uol.com.brEste artigo foi submetido no SGP (Sistema de Gestao de Publicacoes) do BJORL em 22 de fevereiro de 2012. cod. 9056.Artigo aceito em 7 de junho de 2012.

Tympanic membrane perforation caused by traumatic asphyxia.

Residencia Medica em Otorrinolaringologia (Medica Residente do 1o ano de Otorrinolaringologia).Hospital Universitario Getulio Vargas.Endereco para correspondencia: Fernando Luiz Westphal. Hospital Universitario Getulio Vargas, Coordenacao de Ensino e Pesquisa. Av. Aripuana, no 04, Praca 14 de Janeiro. Manaus - AM. Brasil. CEP: 69020-170.E-mail: f.l.westphal@uol.com.brEste artigo foi submetido no SGP (Sistema de Gestao de Publicacoes) do BJORL em 22 de fevereiro de 2012. cod. 9056.Artigo aceito em 7 de junho de 2012.