Luiz Felippe Judice

Endotracheal Inflammatory Pseudotumor: The Role of Interventional Bronchoscopy

We present the case of a 31-year-old woman with recurrent pneumonia. A chest roentgenogram, a chest computed tomographic scan, and a rigid bronchoscopy revealed a mass in the left mainstem bronchus, which was protruding into the trachea and right mainstem bronchus, with no extraluminal component. Endoscopic biopsies confirmed an inflammatory myofibroblastic tumor. The patient was treated with two sessions of bronchoscopic resection, followed by medical therapy with corticosteroids and azathioprine. She has been followed-up for 31 months without complications or recurrence. Although the usual treatment for this type of entity is surgical excision, endoscopic resection may be an adequate oncologic procedure when the tumor is completely endoluminal, as in this case.

Desnutrição materna durante a lactação em ratos Wistar: efeitos sobre as fibras elásticas da matriz extracelular na traqueia dos filhotes

OBJECTIVE To investigate the effects of maternal protein malnutrition during lactation on the elastic fibers in the tracheas of Wistar rat pups. METHODS At delivery, 12 male pups of two Wistar rat dams were equally divided into two groups: control, in which the dam received water and standard rat chow ad libitum during lactation; and protein-restricted (PR), in which the dam received water ad libitum and an isoenergetic PR diet (8% protein). At 21 days of age, the pups were killed and their tracheas were excised. The elastic fibers were stained with Weigerts resorcin-fuchsin (after oxidation) and evaluated under light microscopy. Morphometric determinations were performed by stereology, with the point-counting method, and expressed as volumetric densities. RESULTS Elastic fibers, most having a longitudinal distribution, were identified beneath the tracheal mucosa. In addition, well-defined circular layers of elastic fibers were found around the inner and outer surfaces of the cartilaginous ring. There were no differences between the groups regarding the organization and distribution of the elastic fibers. The volumetric density of the elastic fibers of the pups in the control and PR groups was 2.46 ± 0.99% and 3.25 ± 1.13%, respectively (p < 0.01). CONCLUSIONS The volumetric density of elastic fibers appears to be greater in rat pups breastfed by dams receiving a PR diet than in those breastfed by dams receiving a normal diet.

Revisão do sistema de estadiamento tumor-nódulo-metástase para câncer de pulmão: mudanças e perspectivas

The tumor-node-metastasis (TNM) staging system for lung cancer has been modified since its first edition in the late 1960s. Its seventh edition has been recently published and, for the first time, a truly worldwide database was analyzed in order to propose modifications in the staging. Significant changes have been made in the tumor and metastasis descriptors. Although the recommendations for the node descriptor have remained unchanged, the analysis of the factors related to this descriptor suggests that modifications will be made in the future. The forthcoming revisions of the TNM staging system might take the molecular aspects of lung cancer into consideration, aiming at a more refined staging system.

Structure and Concentration of Elastic System Fibers in the Trachea of the Rat

La matriz extracelular es un elemento clave en la morfologia y fisiologia de la traquea, tanto en estados normales como patologicos. Sin embargo, poco se sabe acerca de su composicion y organizacion. Se llevo a cabo un estudio detallado de la organizacion morfologica y la densidad volumetrica de fibras del sistema elastico en la traquea de ratas Wistar. Se utilizaron seis ratas Wistar edad de 45 dias de vida. La traquea fue extraida despues de anestesia con tiopental y la perfusion a traves del ventriculo izquierdo con solucion salina tamponada seguido de solucion de formalina. Las muestras fueron fijadas en formalina e incluidas en parafina y se procesaron histologicamente. Las fibras del sistema elastico fueron evaluadas en microscopia de luz utilizando la tecnica de Weigert, resorcina-fucsina despues de la oxidacion con Oxone. Los estudios morfometricos fueron realizados por el metodo de conteo de puntos. Las cantidades se expresaron (%, media) como la densidad volumetrica y se determinaron en 25 campos al azar para cada animal. Las fibras elasticas del sistema fueron identificadas por bajo la mucosa traqueal que muestra principalmente un perfil longitudinal. Tambien se encontraron algunos haces de fibras oblicuas en esta region, formando una red irregular de tejido elastico. Cerca de la superficie interna del anillo cartilaginoso, una capa bien definida circular esta presente. La densidad volumetrica de las fibras del sistema elastico en la traquea de ratas Wistar fue de 2,46 ± 0,99%. Los datos del presente estudio proporcionan informacion inicial sobre las fibras del sistema elastico de la traquea de rata, que puede ser utilizado como un modelo para el estudio de la morfologia de las vias respiratorias humanas. Los resultados reportados en este documento constituyen la base de investigaciones continuas en la traquea de la matriz extracelular por estereologia.

Asymptomatic giant mediastinal mass: a rare case of thymolipoma

Thymolipoma is a very rare benign neoplasm of the thymus. We present the case of a 42-year-old male with a massive mediastinal tumor discovered on a chest X-ray after a motorcycle accident. The patient had no complaints, and his physical examination was unremarkable. Chest CT scans revealed a lipomatous mass containing areas of soft tissue density. The patient was submitted to median sternotomy expanded to left anterolateral thoracotomy, resulting in the complete excision of the tumor. The pathological diagnosis was thymolipoma. Thymolipoma usually attains enormous dimensions by the time of diagnosis, and the occasional symptoms are related to compression of adjacent structures. Surgical resection is the treatment of choice and offers the only possibility of cure. The airway deserves special care during anesthesia induction.

DESCRITORES EM CIÊNCIAS DA SAÚDE NAS TESES E DISSERTAÇÕES DE MESTRADO, NA ÁREA DE DOENÇAS RESPIRATÓRIAS

The process of indexing consisted of two phases: firstly, to identify and represent the intellectual contents of a document; and secondly, the translation of the subject analysis into a specified languague, with the aid of subject headings. At the Instituto de Doencas do Torax da UFRJ medical library, the indexing of biomedical journals and theses was performed through a controlled vocabulary - the DeCS (Subject Headings on Health Sciences). The purpose of this study was to identify if the authors of Master Degree thesis on respiratory diseases were using the DeCS for indexing. The subject headings of 29 Master theses from 1990 through 1996 were studied. The data collection showed that 29 authors employed 101 subject headings (3,48 headings/author). Four (14%) of authors utilized adequate subject headings from the DeCS. In conclusion: fourteen per cent of authors of Master theses on respiratory diseases employed correctly the subject headings.

Lung Cancer Staging

Lung cancer incidence has dramatically risen in the past century. It is now the leading cause of cancer death in the world, both among men and women. Accurate staging is important because treatment options and prognosis differ significantly by stage. If there are no distant metastases, the status of mediastinal lymph nodes is the critical point to distinct between patients who will benefit from surgical therapy, neoadjuvant therapy or clinical treatment. Noninvasive imaging studies including chest computed tomography and positron emission tomography scanning should be performed in all patients who are potentially candidates to pulmonary resection. The findings of these noninvasive studies are critical, and the invasive mediastinal staging must be performed according to the medical examination and the results of noninvasive tests. In patients with extensive mediastinal infiltration by lung cancer, the disease is considered advanced and invasive staging is not needed. In patients with mediastinal lymph node enlargement seen at computed tomography, a sample tissue of these nodes is necessary. In these cases there are several methods to invasive staging the mediastinum, but mediastinoscopy is the gold standard. In patients with clinical T2 or with central tumors, invasive staging of the mediastinal nodes is necessary. Patients with a peripheral clinical T1 lung cancer do not usually need invasive confirmation of mediastinal nodes unless there is an abnormal standard uptake value in the nodes, found on positron emission tomography scanning. The staging of patients with left upper lobe tumors should include an assessment of the preaortic and aortopulmonary window lymph nodes. Pancoast tumors always need invasive mediastinal staging if they are considered for surgical resection.

Toracoplastia traumática: relato de caso

Trauma primarily affects young people and is the leading cause of death in the first three decades of life. Flail chest is observed in approximately 10% of all patients with severe chest trauma, and the mortality rate among such patients is 10-15%. We report herein the case of a car accident victim with chest trauma causing hemopneumothorax and multiple rib fractures, intense pain and deformity of the chest wall. Surgical stabilization was performed, with good results. Therapeutic options are also discussed.

Abordagem vídeo-toracoscópica, sem sutura, das perfurações do esôfago torácico diagnosticadas tardiamente

OBJECTIVES to evaluate the use of video-thoracoscopy, in the treatment of late perforations of the thoracic esophagus, without suture or organ resection. METHODS retrospective analysis of patients with late diagnosis (> 12 hours) of thoracic esophageal perforation treated by video-thoracoscopy, without suture or organ resection, over a 15-year period. RESULTS sixteen patients were operated on, ten men and six women, aged between 48 and 66 years, with time between the diagnosis of the perforation and the surgery ranging from 16 to 26 hours. All patients underwent video-thoracoscopy, with pulmonary decortication, pleural loculations approach, opening of the mediastinal pleura near the perforation site and debridement of the devitalized tissues, followed by double drainage of the pleural cavity. No esophageal suture or resection was performed, and the patients evolved with complete closure of the lesions, without deaths. CONCLUSION the video-thoracoscopic surgical approach was able to control pleural infection, pulmonary expansion and enable complete regeneration of the esophagus with late-diagnosed perforation.

Nutrition and tracheal morphology; does malnutrition lead to characteristics of premature aging?

Interest in tracheal surgery and invasive airwayendoscopic procedures has increased in the last twodecades. This is a direct consequence of the aging ofpopulation and improvement in intensive care units.The most prevalent airway disease requiring surgery orinvasive endoscopic procedure is tracheal stenosis. Theoccurrence of this disease is related to abnormalhealing after injury to mucosa, usually by orotrachealor tracheostomy tube. Importantly, this healing processis initiated in, and coordinated by, the extracellularmatrix.