Roberto Saad Junior

Avaliação da função pulmonar na obesidade graus I e II

BACKGROUND: Obesity can effect the thorax, diphragm and abdominal muscles, thereby resulting in altered respiratory function. OBJECTIVE: To evaluate the effects of obesity and to determine whether body mass index (BMI) and waist circumference correlate with spirometry values in obese individuals. METHOD: We studied 96 non-smokers of both sexes, 48 suffering from class I and class II obesity and ranging in age rom 18 to 75. All participants presented a BMI between 30 kg/m2 and 40 kg/m2 and none had a history of morbidity. Spirometry was performed, and waist circumferences were measured. RESULTS: No significant differences were found between the spirometric values of men with class I or II obesity and those of non-obese men. In obese women, forced vital capacity and forced expiratory volume in one second (FEV1) were significantly lower than in women who were not obese. Obese individuals of both sexes presented significantly lower expiratory reserve volume (ERV) than did non-obese individuals. Although inspiratory capacity was greater in obese men and women, the difference was significant only for the men. In obese men, there was a significant negative correlation, not seen in the women, between waist circumference and FEV1. CONCLUSION: Pulmonary function is altered in women suffering from class I and II obesity. In obese men, although pulmonary function is unaffected by BMI, we observed a significant negative correlation between BMI and ERV. We can conclude that pulmonary function is influenced by waist circumference in men suffering from class I and II obesity.

Aplicação terapêutica da ventilação colateral com drenagem pulmonar no tratamento do enfisema pulmonar difuso: relato dos três primeiros casos

OBJECTIVE To report the results obtained in three patients with diffuse pulmonary emphysema during the pre- and post-operative periods following a new surgical technique: collateral ventilation with lung parenchyma drainage. METHODS Patients suffering from pulmonary failure and disabling dyspnea, despite having received the gold standard treatment, including pulmonary rehabilitation, were selected for the evaluation of pulmonary drainage. During the pre- and post-operative periods, patients were submitted to plethysmography and six-minute walk tests, as well as completing the following quality of life questionnaires: Medical Outcomes Study 36-item Short-Form Health Survey, Saint Georges Respiratory Questionnaire, Eastern Cooperative Oncology Group Performance Status and Medical Research Council Scale. In all three cases, the postoperative follow-up period was at least 300 days. The tests were performed at the following time points: during the pre-operative period; between post-operative days 30 and 40; and on post-operative day 300. Data were analyzed using profile plots of the means. RESULTS When the results obtained in the pre-operative period were compared to those obtained at the two post-operative time points evaluated, improvements were observed in all parameters studied. CONCLUSIONS The results suggest that the surgical technique proposed for the treatment of patients suffering from severe diffuse emphysema successfully reduces the debilitating symptoms of these patients, improving their quality of life considerably.

Avaliação da função respiratória em indivíduos submetidos à abdominoplastia

BACKGROUND: To prospectively evaluate respiratory function using spirometric parameters in patients who underwent abdominal plastic surgery. METHODS: We studied 33 healthy non-smoking women that were submitted to abdominoplasty and presented normal results for thorax radiography made prior and four days after surgery. Spirometric tests were performed on the fourth, fifteenth and thirtieth day after surgery. RESULTS: Spirometric tests performed showed that, except for FEV1/FVC and FEF 25% - 75%/FVC, rewations, all other measured parameters (FVC, FEV, FEF 25% - 75% and PFE) were significantly decreased by the fourth postoperative day in relation to pre-surgical values. On the thirtieth post-surgery day FCV and PFE values were unsideted normal. Otherwise, FEV1 values were still significantly decreased compared to pre-surgical values even at the last evaluation. Spirometric tests evidenced that, except for the relation FEV1/FVC and FEF 25% - 75%/FVC, all other measured parameters (FVC, FEV, FEF 25% - 75% and PFE) were significantly decreased in the fourth post-surgery day in relation to presurgical values. FCV and PFE values were normal at the evaluation performed on the thirtieth post-surgery day. Otherwise, FEV1 values were still significantly decreased compared to pre-surgical values, even in the last evaluation. CONCLUSION: In conclusion, pulmonary function were significantly decreased in the fourth post-surgery day, with normalization at the thirtieth post-surgery day.

Estudo comparativo entre as anastomoses cervicais esofagogástrica término-terminal com e sem invaginação após esofagectomia para câncer

OBJECTIVE To assess the incidence of fistula and stenosis of cervical esophagogastric anastomosis with invagination of the esophageal stump into the gastric tube in esophagectomy for esophagus cancer. METHODS Two groups of patients with thoracic and abdominal esophagus cancer undergoing esophagectomy and esophagogastroplasty were studied. Group I comprised 29 patients who underwent cervical esophagogastric anastomosis with invagination of the proximal esophageal stump segment within the stomach, in the period of 1998 to 2007 while Group II was composed of 36 patients submitted to end-to-end cervical esophago-gastric anastomosis without invagination during the period of 1989 to 1997. RESULTS In Group I, esophagogastric anastomosis by invagination presented fistula with mild clinical implications in 3 (10.3%) patients, whereas in Group II, fistulas with heavy saliva leaks were observed in 11 (30.5%) patients. The frequency of fistulas was significantly lower in Group I patients (p=0.04) than in Group II. In Group I, fibrotic stenosis of anastomoses occurred in 7 (24.1%) subjects, and 10 patients (27.7%) in Group II evolved with stenosis, while no significant difference (p=0.72) was found between the two groups. CONCLUSION In esophagectomy for esophagus cancer, cervical esophagogastric anastomosis with invagination presented a lower rate of esophagogastric fistula versus anastomosis without invagination. Stenosis rates in esophagogastric anastomosis proved similar in both approach with or without invagination.

Caso raro de pneumotórax: adamantinoma metastático

Here, we describe two cases of lung metastasis of adamantinoma of long bones, a low-grade bone neoplasm that rarely metastasizes. In both cases, the clinical presentation of the metastases was characterized by spontaneous pneumothorax secondary to tumor cavitation, a phenomenon described in only three of the studies reviewed in the literature. Clinical, radiological, and anatomopathological findings, as well as the procedures adopted in the two cases, are described.

Surgical treatment of giant emphysematous lung bullae

OBJECTIVE Lack of Brazilian publications regarding this disease in Brazil led us to perform the current work to describe the historical evolution and to analyze results of the surgical treatment of Giant Emphysematous Lung Bullae at the Santa Casa de São Paulo. METHODS We have retrospectively assessed, between January 1979 and June 2005, the medical records of 83 patients submitted to one of four surgical modalities: the thoracoscopic bullectomy, VATS bullectomy, VATS bullae drainage and bullae drainage with local anesthesia, totaling 92 surgeries. Parameters analyzed were hospitalization time, post-surgical complications, perioperative and late mortality in addition to clinical and functional pre- and post- surgical parameters. RESULTS Morbidity was 40.2% and early post-surgical mortality 4.3%. Post-surgical complications were associated to the patients morbid history. Factors such as diffuse pulmonary emphysema, multiple bullae and age did not influence early complications. There was an improvement in the symptomatology and functional results in 94.5% of the patients. There was no return on he operated bullae. Mortality five years after surgery was of 18.3% and arose, primarily from clinical progression of the diffuse pulmonary emphysema. CONCLUSIONS Several surgical modalities were performed to treat the emphysematous lung bullae, from bullectomy to thoracotomy, at the initial phase until drainage of the bullae with local anesthesia and sprayed talc, the currently preferred modality. Regardless of the method used, however, notwithstanding the relatively high morbidity, post-surgical results are highly favorable with low mortality and uncontestable clinical-functional improvement of the operated patients.

Teratoma de mediastino com degeneração maligna

Here, we report the case of a patient with a slowly-progressing anterior mediastinal teratoma submitted to surgical resection. The anatomopathological examination of the sample revealed malignant degeneration to carcinoid tumor. Such evolution is very rare, and we have found only three related studies in the literature. We describe the clinicopathological features of the tumor and discuss the treatment administered. The evolution was satisfactory, and the patient was submitted to oncological treatment.

Videotoracoscopia no trauma de tórax

OBJETIVOS: Com o intuito de definir a funcao da videotoracoscopia no diagnostico e tratamento no trauma toracico, foram estudados 51 traumatizados por traumas penetrantes ocasionados por arma branca, ferimentos por projetil de arma de fogo ou traumas fechados do torax, com suspeita diagnostica por exame clinico e/ou radiologico de lesoes toracicas. METODOS: Foram selecionados doentes estaveis vitimas de trauma toracico (pressao arterial sistolica igual ou superior a 90mmHg) com diagnostico de: hemotorax em 20 (cinco hemotorax estacionarios, quatro hemotorax progressivos e 11 hemotorax coagulados), contusoes e ferimentos precordiais (tres), ferimentos da zona de transicao toraco-abdominal (24), corpo estranho no torax (dois) e ferimentos transfixantes do mediastino (dois). Todos foram submetidos a videotoracoscopia. RESULTADOS: A videotoracoscopia se mostrou eficiente na investigacao diagnostica nos casos de hemotorax progressivo (quatro casos), hemotorax coagulado (11 casos), contusoes e ferimentos precordiais (tres casos), ferimentos da zona da transicao toraco-abdominal (confirmacao de nove lesoes diafragmaticas em 24 traumatizados examinados, 37,5%) e corpos estranhos no torax, retirada do corpo estranho com sucesso (dois casos). O procedimento tambem foi eficiente, alem do diagnostico, no tratamento de hemotorax progressivo (ligadura de arteria mamaria um caso, cauterizacao de vasos intercostais um caso), hemotorax coagulado (remocao de coagulos e decorticacao, 11 casos) tendo evitado a realizacao de toracotomia em 33,3% dos traumatizados examinados. CONCLUSOES: A videotoracoscopia e metodo eficiente para diagnostico e tratamento no traumatismo do torax e ainda pode evitar a toracotomia em expressivo numero de pacientes submetidos ao procedimento.

Lipossarcoma de mediastino: relato de caso

Here, we describe the case of a 51-year-old female with mediastinal liposarcoma. Liposarcoma is the most common malignant mesenchymal neoplasm in adults, although a mediastinal location is extremely rare. It has a large volume and varied histologic subtypes. It is characterized by the compression of neighboring structures. Computed tomography and magnetic resonance imaging provide useful data for diagnosis. Tissue biopsy and histological typing are very important in determining the treatment and are needed for the final diagnosis. Radiotherapy and chemotherapy are ineffective treatment modalities. According to the literature, surgical resection is the treatment of choice. Long-term follow-up evaluation is indicated since there is a high rate of recurrence.

Tuberculose do timo

Tumors of the anterior mediastinum include several entities with different radiological and clinical manifestations, constituting a heterogeneous group of congenital, inflammatory, and neoplastic conditions. Among these lesions, the most common primary tumor of the mediastinum is thymoma, nearly followed by germ cell tumors and lymphomas. Tuberculosis of the thymus, an extremely rare condition, typically involves Qthe mediastinal lymph nodes. We present, in this study, pathological, radiological, and clinical findings of one case of tuberculosis of the thymus in an 18-year-old patient who presented thoracic pain, dyspnea upon minimal effort, and progressive worsening of the symptoms in one week. The chest X-ray showed a large mass in the mediastinum, and computed tomography scans indicated that it was located anteriorly. The patient was submitted to surgery in order to excise the mass. Microscopy revealed a massive inflammatory response and granulomas in the thymic tissue. Ziehl-Neelsen staining for acid-fast bacilli yielded positive results, and a diagnosis of tuberculosis was made. Surgeons and pathologists should remain alert for this condition and should include it in the differential diagnosis of mediastinal masses.