Rui Haddad

Symptomatic mucocele after esophageal exclusion

Surgical exclusion of the thoracic esophagus can result in the accumulation of secretions and dilatation of the esophageal remnant, a clinical picture known as esophageal mucocele. Although it is usually asymptomatic, if it increases in size it can produce a variety of compressive symptoms such as coughing, chest pain and respiratory distress. We present two cases of symptomatic mucocele after esophageal exclusion treated successfully with surgical resection. We believe that surgical resection should be considered for symptomatic patients, and that esophageal bypass surgery should be used with caution and indicated mostly in patients with a limited life span or with contraindications for esophagectomy.

Aspectos clínico-patológicos do carcinoma bronquioloalveolar e sobrevida em pacientes no estágio clínico I

OBJECTIVE: To analyze the clinicopathological aspects of bronchioloalveolar carcinoma (BAC) and the survival in a sample of patients at clinical stage I. METHODS: A retrospective study involving 26 patients diagnosed with clinical stage I BAC and undergoing surgery at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro, in the city of Rio de Janeiro, Brazil, between 1987 and 2007. We analyzed clinicopathological and radiological aspects, as well as mortality and survival. The data, which were collected from the medical charts of the patients, were statistically analyzed. RESULTS: Females predominated (n = 16). The mean age at diagnosis was 68.5 years. Most patients were active smokers (69.2%). The most common forms of presentation of BAC were the asymptomatic form (84.6%) and the nodular form (88.5%). Involvement of the upper lobes predominated (57.7%). Stage IB was the most common pathological stage, followed by stages IA and IIB (46.2%, 38.4% and 15.4%, respectively). There was no in-hospital mortality. Four patients died during the postoperative follow-up, with a mean disease-free survival time of 21.3 months. The overall five-year survival rate was 83%. The probability of survival for the patients diagnosed after 1999 showed a trend toward an increase when compared with that for those diagnosed up through 1999 (three-year survival rate: 92% vs. 68%; p = 0.07). CONCLUSIONS: The clinicopathological aspects of this study sample were similar to those of patients with BAC evaluated in previous studies.OBJECTIVE To analyze the clinicopathological aspects of bronchioloalveolar carcinoma (BAC) and the survival in a sample of patients at clinical stage I. METHODS A retrospective study involving 26 patients diagnosed with clinical stage I BAC and undergoing surgery at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro, in the city of Rio de Janeiro, Brazil, between 1987 and 2007. We analyzed clinicopathological and radiological aspects, as well as mortality and survival. The data, which were collected from the medical charts of the patients, were statistically analyzed. RESULTS Females predominated (n = 16). The mean age at diagnosis was 68.5 years. Most patients were active smokers (69.2%). The most common forms of presentation of BAC were the asymptomatic form (84.6%) and the nodular form (88.5%). Involvement of the upper lobes predominated (57.7%). Stage IB was the most common pathological stage, followed by stages IA and IIB (46.2%, 38.4% and 15.4%, respectively). There was no in-hospital mortality. Four patients died during the postoperative follow-up, with a mean disease-free survival time of 21.3 months. The overall five-year survival rate was 83%. The probability of survival for the patients diagnosed after 1999 showed a trend toward an increase when compared with that for those diagnosed up through 1999 (three-year survival rate: 92% vs. 68%; p = 0.07). CONCLUSIONS The clinicopathological aspects of this study sample were similar to those of patients with BAC evaluated in previous studies.

Anatomic pulmonary resection by video-assisted thoracoscopy: the Brazilian experience (VATS Brazil study)

ABSTRACT Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority-521 (89.8%)-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries.

Pneumotorax e pneumopericárdio hipertensivo em cirurgia cardiotorácica

Herein, we report two cases of pneumothorax and tension pneumopericardium after cardiothoracic surgery. Both patients underwent pericardiotomy during the primary operation and developed pericardial tamponade as a complication. The treatment was tube thoracostomy, and both patients recovered completely.

Tratamento cirúrgico de cisto broncogênico paratraqueal por mediastinoscopia cervical

Os cistos broncogenicos do mediastino sao lesoes benignas congenitas, usualmente descobertas na idade adulta. O tratamento cirurgico classico, quando indicado, e a resseccao da lesao por toracotomia ou por videotoracoscopia. Descrevemos aqui um caso em que foi realizada a resseccao completa de um cisto broncogenico paratraqueal por mediastinoscopia cervical, com uma breve revisao e discussao da literatura.

Effects of early and late pneumothorax drainage on the development of pulmonary oedema.

We analyzed the effects of pneumothorax duration and early or late drainage on lung histology and biological markers associated with inflammation, alveolar fluid clearance, and pulmonary oedema formation. Pneumothorax was induced by injecting air into the thorax of anaesthetized rats, which were randomized according to duration of pneumothorax [5 (PTX5) or 30 (PTX30)min] and further divided to be drained (D) or not (ND). ND rats were euthanized at 5 and 30min. In D groups, pneumothorax was drained and rats breathed spontaneously for 30min. PTX30-ND, compared to PTX5-ND, showed higher alveolar collapse and oedema, type III procollagen, caspase-3, epithelial sodium channel-α, and aquaporin (AQP)-1 mRNA expression, and epithelial and endothelial damage, with reduced cystic fibrosis transmembrane conductance regulator (CFTR) and AQP-3 expression. PTX5-D, compared to PTX30-D, showed less alveolar hyperinflation, oedema, and alveolar-capillary damage, with reduced interleukin-6, caspase-3, AQP-5, and Na,K-ATPase-α and -β expression, and increased CFTR expression. In conclusion, longer duration pneumothorax exacerbated lung damage, oedema, and inflammation.

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.

Efeitos do sulfato de bário na cavidade pleural de ratos

BACKGROUND: Evaluate the effects of barium sulphate in rats pleural cavity. METHOD: The effects due to the presence of 100% barium sulphate in the pleural cavity of 43 rats were experimentally assessed. After inhaled ether anesthesia, 1 ml of radiological contrast was injected via subxiphoid through a blunt needle into the right pleural cavity. The animals were divided into 3 groups and were killed with in a closed chamber with ether after 24 hs (13 rats), 48 hs (16 rats) and 21 days (14 rats), respectively. Through a longitudinal sternotomy and laparatomy, both parietal and visceral pleura were extracted along with the rib cage and right lung. Control group was composed of 22 rats which underwent an injection of 1 ml saline 0,9% into the right pleural cavity. RESULTS: No death occurred in 43 rats injected with barium sulphate nor in the control group. There were similar findings in the pleural cavity of animals (barium sulphate) killed at 24h and 48h such as diffuse mild hyperemia in right pleura, free barium sulphate, inflammatory pleural effusion with polymorphonuclears predominating, macrophages phagocyting barium sulphate in the pleura, which presented a polymorphonuclear predominant infiltrate. At 21 days, barium sulphate was found localized and blocked in the retrosternal region with, intense formation of pleural symphises. Pleural histopathology revealed large numbers of barium sulphate filled macrophages, scant extra-cellular barium sulphate pigments, important fibroelastic proliferation in 13/14(92%) cases, without granuloma formation. Histopathology of 22 rats of the control group was considered normal throughout the experiment. CONCLUSIONS: Barium sulphate caused inflammatory pleural effusion in all cases; with no granuloma formation; and no deaths troughout the experiment.

Multidrug-resistant pulmonary tuberculosis

The advent of effective antituberculous medication has greatly diminished the role of surgery in the management of tuberculosis (TB). More recently, diseases that are resistant to medical treatment have emerged as a major challenge. Multidrug-resistant tuberculosis (MDRTB) is defined as resistance to two or more drugs, including rifampin and isoniazid. In such cases, high relapse rates with medical therapy alone have been reported and adjuvant surgical resection has been proposed as a therapeutic option in selected patients. Although many studies have shown good results with this surgical strategy, the role of minimally invasive surgery in this scenario has yet to be established. Here we review the indications of surgical resection for MDRTB and the role of minimally invasive surgery for infectious / inflammatory diseases of the lungs.

New Frontier for Intracardiac Devices: Endobronchial Occlusion of Bronchopleural Fistula With CERA Device

We report on a 57‐year‐old patient suffering from advanced squamous cell carcinoma of the left lung, ultimately submitted to intrapericardial left pneumonectomy with hilar and mediastinal lymphadenectomy. Imaging examination showed a left bronchopleural fistula that needed to be occluded. Due to the patients high surgical risk, endobronchial closure with intracardiac device was performed. The ASD CERA™ device (Lifetech Schenzhen, China) was chosen. The procedure was successful and the patient was discharge from the hospital 5 days thereafter. Endobronchial closure of bronchopleural fistulas with intracardiac devices is feasible and may become an excellent option for those very ill patients.