Thomas A. Horan

Massive gas embolism during pulmonary nodule hook wire localization.

The locaization of pulmonary nodules by the hook wire technique has allowed accurate resection of small and nonsuperficial pulmonary nodules by video-assisted thoracoscopic surgery. Hook wire localization has been shown efficacious and safe with principal complications limited to pneumothorax, wire dislocation, and localized intrapulmonary hemorrhage. We report a case of massive gas embolism complicating this procedure. The probable causative mechanisms and possible methods for avoidance are discussed.

Mediastinoscopic treatment of mediastinal cysts

Selected patients with mediastinal cysts can be managed safely and effectively by mediastinoscopic techniques. Small cysts in favorable locations can be excised partially or nearly completely. Cysts that are intimately associated with vital structures are better suited to mediastinoscopic cystotomy and chemical sclerosis. Three cases are presented and technical aspects are discussed.

Pericardioscopy and biopsy

SummaryThe diagnosis of malignant pericardial effusion is usually made by pericardial fluid cytology or open pericardial biopsy. A case is reported where diagnostic difficulty warranted flexible pericardioscopy under fluoroscopic guidance. The technique is described.

Noninvasive determination of inspiratory pressure in patients with spinal cord injury: what is the best method?

O objetivo deste estudo foi verificar o desempenho da pressao inspiratoria nasal durante o fungar (PInas) e da PImax em individuos com lesao medular traumatica. Foram avaliados 26 pacientes com lesao medular traumatica. Os pacientes tetraplegicos e paraplegicos exibiram diferentes medias do percentual do previsto da CVF, respectivamente, 52 ± 19% e 78 ± 23% (p < 0,05). Ao contrario da PImax, o percentual do previsto medio da PInas foi inferior nos tetraplegicos (p < 0,05) e, em todos os participantes, a correlacao com o nivel da lesao foi significativa (r = 0,489; IC95%: 0,125-0,737). O impacto do melhor discernimento da PInas no diagnostico das alteracoes da funcao inspiratoria de pacientes com lesao medular traumatica merece ser aprofundado.

Fatores de risco de complicações pulmonares em pacientes com sarcoma após toracotomia para a ressecção de nódulos pulmonares

OBJECTIVE: To identify the risk factors for pulmonary complications after thoracotomy for the resection of pulmonary nodules in patients with sarcoma. METHODS: A retrospective cohort study involving 68 consecutive patients diagnosed with sarcoma and submitted to a total of 174 thoracotomies for the resection of pulmonary nodules. The dependent variable was defined as the occurrence of any postoperative pulmonary complications. The independent variables were related to the patient, underlying diagnosis, and type of surgical procedure. We analyzed the data using a multivariate generalized estimating equations model with logistic link function and a symmetric correlation structure. RESULTS: Complications were observed in 24 patients (13.8%, 95% CI: 9.0-19.8), and there was one death. The mean length of hospital stay was twice as long in the patients with postoperative complications as in those without (18.8 ± 10.0 days vs. 8.6 ± 6.0 days; p < 0.05). The variables that correlated with the outcome measure were the type of resection (wedge vs. anatomic; OR = 3.6; 95% CI: 1.5-8.8), the need for blood transfusion (OR = 9.8; 95% CI: 1.6-60.1), and the number of nodules resected (OR = 1.1; 95% CI: 1.0-1.1). The multivariate model showed an area under the ROC curve of 0.75 (95% CI: 0.65-0.85). CONCLUSIONS: Postoperative pulmonary complications were common after pulmonary nodule resection in patients with sarcoma, occurring in approximately 10% of the procedures. The occurrence of such complications can be expected when techniques other than wedge resection are employed, when blood transfusion is required, and when a great number of nodules are resected. Therefore, it is possible to identify patients at risk for pulmonary complications, who should be closely monitored in the immediate postoperative period. In such patients, all preventive measures should be taken.